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Uily <br /> 2°� c°= SANAOAQUIN <br /> — Environmental Health Department <br /> COUNTY— <br /> �, T� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 Inspector: � CONSTRUCTION 11 1 <br /> Facility Address: T _ V 5 6+,j <br /> Well Address: Total Depth: I r <br /> WP# �0LJ U 1j2Z Well#: Drilling Rig Type: 13 Sbr 6 xlAc) <br /> Soil Boring#: <br /> Drilling Company: v W Min 2"Annular EHD Seal Verified: L1 Yes LINO <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: C' 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: coNFLE'noN cDmPPLEncN <br /> Method: Ground Surface <br /> Screening Method: R ori <br /> Verified Chain of Custody: ❑ Yes ONO -�--n' <br /> n. <br /> n. <br /> SPOILS . <br /> Contamination Noted: ❑ Yes IJ No <br /> If yes,spoils storage Location: <br /> slottad = B <br /> sacyon <br /> Covered: ❑ Yes ONO _ = I-w+pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ' <br /> Depth to Water:_/V 2 n• n' <br /> Grout Material: + <br /> 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 Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity MTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> ailons Bas Rall ons Bags <br /> Thickest Thinnest Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 B 1 40 80 8 <br /> Q Q Ln1 ' yI'x� 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952105 1 T 209'468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />