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� 8K� ]U8DU|yJ <br /> ���m��u+*4u/m Environmental <br /> . � . ---(�OU[�TY--- Health Department <br /> ^^~ <br /> ` Gn,omooymvn here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date nspector: CONSTRUCTION <br /> Facility Address: PIP ' <br /> Well Address: l <br /> � Total <br /> yy VP Drilling Rig Type: <br /> Soil - Min Z" Annu|urEHD Seal Verified: [] Yes []NoDhUi Co <br /> Screen Length From: To <br /> Filter Pack From: To <br /> Geologist: ' Bentonite From To <br /> Grout From: To: <br /> Public Water System Onsite�� L1 Yes ONo <br /> COMPLETION L] Stove Pipe [lChristieBox <br /> Domestic Well Onsite: El Yes []No <br /> casing <br /> |fyes, location and distance: height <br /> S/UVUqJYWG o <br /> Holding Temperature: omepLsrxrm COMPLETION <br /> ^^`"=' <br /> Method: anounuouwf=w <br /> Screening Method: grout <br /> Verified Chain ofCustody: [] Yeo El No <br /> SPOILS -----'- � <br /> � <br /> Contamination Noted: LJ Yes []No � <br /> |fyes, spoils storage Location: 1 � <br /> *�« n � | <br /> Covered: [] Yes []No - � <br /> g-vw Pack <br /> |fyes, material: <br /> tept_ht uVVater: 7b, <br /> Grout Material: <br /> Gallons ofGrout Used: MATERIALS/DEVELOPM ENT <br /> � <br /> Casing Type: <br /> VVe|| installation E]VVe|| Destruction Blank Feet Screen Feet <br /> []BorinQ |nsta||ation []8orinQDestruction Slot Size: <br /> Bags ufCement: <br /> METHOD USED 8aQsSand/Grave|: <br /> Type/8randofBentonite: <br /> []Pressure Grout []{)verDri|| ' <br /> FiIter Pack Tvpe/3ize: <br /> [] Gravity /Tremie []Other: Type of Method: <br /> Water Cement 47 1 b Water Cement 94 lb <br /> gallons Bags gall! S Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 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 /> 10 20 4 20 40 4 <br /> 15 30 go 60 6 <br /> 17.5 35 70 7 <br /> 10/16/7O17 <br /> 1888E. Hazelton Avenue I Stockton, California 952O51 T 208468'34201 F 2O0484'0138 1 <br />