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SAN 10AQUIN Environmental Health Department <br /> • I i -----COU N T Y— <br /> \`�9ro N Greatness grows here. <br /> MonitoringQWell/Soil Boring Inspection Report <br /> Date: �A�q Inspector: CONSTRUCTION <br /> Facility A dress: <br /> Well Address: l0 V&' lir h CTotal Depth: <br /> WP# a-3qS Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: e Min 2"Annular EHD Seal Verified: El Yes 11 No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ✓ra3�bv< <o I Filter Pack From: To: <br /> Geologist: ­5 OL.wte.S Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION GCMP�LETION <br /> Method: Ground"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes L1 No IIr -it. <br /> ft. <br /> n. <br /> SPOILS - — <br /> Contamination Noted: ❑ Yes 11 No =` <br /> If yes, spoils storage Location: atonal <br /> a.cyon <br /> Covered: ❑ Yes ❑No = =_ <br /> pnvat pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: IFI• =_ <br /> Depth to Water: rxA JL <br /> GroutMaterial: <br /> Gallons of Grout Used: „, pµ� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> 'Nell Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> `F�Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 941b <br /> allons 8a eallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3%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 /> 3 6 / 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 www.s4cehd.com <br />