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` SAN 10AQUIN <br /> ,2 Environmental Health Department <br /> —COUNTY- -- <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I3 ( Inspector: Salre CONSTRUCTION <br /> Facility Address: F ,'r, <br /> Well Address: Total Depth: ((11 <br /> WP# Well#: Drilling Rig Type: sqyt4G <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: �(XNf Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING AWVE..oaouNO CHR _ <br /> Holding Temperature: COMPLETION GOMP�LETION <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No n' <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No = <br /> Ar <br /> If yes, spoils storage Location: slotted <br /> saclon <br /> Covered: ❑ Yes ❑No = gravel * <br /> If yes, material: r <br /> GROUTING or DESTRUCTION Total Depth: it <br /> Depth to Water: n• tt' <br /> Grout Material: Q,Q MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction <br /> �j6 „�/,Bags of Cement: <br /> METHOD USED OUG P�Iw�qV w Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity1Tremie ❑Other: Type of Method: <br /> Water ement 471 Water Cement 941b <br /> gall s Bas allons Bags <br /> Thickest Thinnest ltBags Thickest Thinnest If Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 5� (Dag <br /> S Vq �(� O � I n( /��-(}' 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 19520 T 209 468--3`420"t`F" 209 464-0138 www.s6cehd.com <br /> I I I I 1 <br />