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SAN 0AQUIN' Environmental Health Department <br /> COUNTY <br /> 9cFoar•,. Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 6 Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: _ <br /> WP# D()40 0 Wei#: Drilling Rig Type: <br /> Soil Boring#: _ t t0 S 'r t <br /> Drilling Company: �, ._ �� Min 2" Annular EHD Seal Verified: El Yes El No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> S� /' ku - Grout From: To: <br /> Public Water System Onsite: El Yes ONO i)OMPLETION ❑ 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: COWLEfION COMPLETION <br /> Method: Ground Surlwe — <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> — a <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: <br /> sac�on <br /> <^ _ <br /> Covered: ❑ Yes ❑No = 9-vol <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:( ) <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation.l(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 /> ,mi-pravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest nest a s Thickest Thinnest aBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 25 s 1 5 10 1 Bentonite per 47 lb 1.411 2.47 <br /> s l0 2 10 20 2 Bentonite per 94 lb 2.821 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 1 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />