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SAN.PJO <br /> A <br /> -COUNTY Environmental Health Department <br /> ! � COU — <br /> , <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: q/110 Inspector: Euy-4 CONSTRUCTION <br /> Facility Address: 1�j ( iku cr 1 r Dl/ FL 6���5� <br /> Well Address: Total Depth: <br /> WP# L(()D 12 Well#: Drilling Rig Type: <br /> Soil Boring#: � % Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: (a(-eqq <br /> Driller Onsite: Screen Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETJON COMP�LEnoN <br /> Method: Ground Surface <br /> Screening Method: ori <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: Sion" = . <br /> aec5cn <br /> Covered: 1:1 Yes El No <br /> = �w <br /> If yes, material: iZ <br /> .. <br /> GROUTING or DESTRUCTION Total Depth: j U __ <br /> Depth to Water: S Ft n• tt' <br /> IF <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ` Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Bas RaI1111 ons Bags <br /> Thickest Thinnest aBags Thickest Thinnest Jt 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 1 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 35 707 <br /> 20 + 40 8 40 80 8 <br /> Z bq-911 W/� -LI°J &tau VGL� �2V b a10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.svicehd.com <br />