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$QN �OQQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness gross here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: q 222j Inspector: l CONSTRUCTION <br /> Facility Address: (-V <br /> Well Address: Total Depth: <br /> WP#om !8(� ����� Well#: Drilling Rig Type: <br /> Soil Boring#: µ12 Mt�R Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: Qej2n l Driller Onsite: Screen Length From: To: <br /> Consultant: (1pn Filter Pack From: To: <br /> Geologist: CIA 0 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box1 , yy�� <br /> Domestic Well Onsite: ❑Yes El No casing <br /> If yes, location and distance: � height <br /> SAMPLING T VW� <br /> ABOVE-GROUND CHRMN-BOX <br /> Holding Temperature: corFLEr1°N COMPLETION ! A (JP(ad <br /> Method: GroundSulacs <br /> Screening Method: grow ( ld <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> 5, <br /> N. <br /> SPOILS <br /> 1 'V <br /> Contamination Noted: ❑ Yes ❑No J`J � lUyy �4 = 4 N` <br /> If yes,spoils storage Location: T` 22 <br /> awned & n J <br /> Covered: El Yes ❑No r1� � secdon <br /> If yes,material: _ `.. <br /> GROUTING or DESTRUCTION Total Depth: �'�. 5 27j, tt _ 1 tt 1 f 0„ , <br /> Depth to Water: i <br /> Grout Material: �_a� C.2XrBr\1 <br /> Gallons of Grout Used: S D at�7 MATERIALS DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> p Bags of Cement: <br /> METHOD USED Ivy Bags Sand/Gravel: <br /> :5sov l rver� Type/Brand of Bentonite: <br /> []Pressure Grout ❑Over Drill ((JJ <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ment 471 Water Cement 94lb <br /> allons Ba s stations Bags <br /> Thickest I Thinnest ags Thickest I Thinnest #Bags Bentenite(Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 v 5 10 1 Bentonite per 47 lb 1.411 2.47 <br /> 5 10 2 V' 10 20 2 Bentonite per 94 lb 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 V 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 <br /> 20 40 8 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 1 www.smcehd.com <br />