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SANr1UAQUIN <br /> Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: NZjV 2551spector: Nw" CONSTRUCTION V\V3 L rpm✓ 2—� <br /> Facility Address: <br /> Well Address: Total Depth: �L <br /> WP# `'L5a r 3',0 Well#: 1(iU_ 7,^7 Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: Yes []NoDrilling Company: (11 p,.0 c.C�i"C- <br /> Driller Onsite:_�j� ,1J�o�' Screen Length From; 2t To: \ t <br /> Consultant: Filter Pack From:-1 To: ' <br /> Geologist: Bentonite From: ' To: ' <br /> Grout From: (Z- To: ,S�y x �� <br /> Public Water System Onsite: Yes El No \J= <br /> COMPLETION ❑ Stove Pipe E2Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: cowmEnoN C0MPP=CN <br /> Method: G=nd Sud woo <br /> Screening Method: grout <br /> Verified Chain of Custody: ElYes El No 12 S n. <br /> 2L ft. 7 E <br /> ft. <br /> SPOILS <br /> o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: _ <br /> x1otted ` c <br /> i <br /> .on �s = <br /> Covered: El Yes ❑Noadc <br /> P. <br /> If yes, material: <br /> GROULN r DESTRUCTION Total Depth:: .: A <br /> Depth to Water: q`f <br /> Grout Material: A).e MATERIALS/DEVELOPMENT <br /> Gal ons of Grout Used: c' <br /> Casing Type: <br /> Well 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 /> Type/Brand of Bentonite: <br /> ❑Pressure Grout []Over Drill <br /> �� Filter Pack Type/Size: <br /> El Gravity ErTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gall ons Bags <br /> Thickest Thinnest 4Bags 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 /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 1 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 1 50 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 1 70 7 <br /> 20 40 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1www.sLcehd.com <br />