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SANs10AQUIN <br /> Environmental Health Department <br /> - -COUNTY --- <br /> °�cP✓ Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:Ogy* 5-7'"2e-14e) I n s p e ct o r: A41111 CONSTRUCTION <br /> Facility Address: 12 y3 4 6 <br /> Well Address: Total Depth: <br /> WP# ,,q& 11n 71-/_3 Well#: Drilling Rig Type: �/i1F <br /> Soil Boring#: <br /> Drilling Company: a/% � 4 !i Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: ' Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist:, 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 /> —1w, <br /> SAMPLINGABOVE-GROUND <br /> Holding Temperature: COe,�LETION enoN <br /> Method: Gmnd Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> it. <br /> SPOILS = <br /> 2e, <br /> Contamination Noted: ❑ Yes El No S, <br /> If yes,spoils storage Location: 37 1,,e /D .baa <br /> 50clian — <br /> Covered: ❑ Yes ❑No <br /> g-VW Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:' =_ <br /> Depth to Water: /7(— 2c' / M ft. <br /> Grout Material: Ive4 "lle"Ill <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Coring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Q"Gravity Cl'lremie ❑Other: Type of Method: <br /> nti471b Water Cement 941b <br /> allons) aallons Bags <br /> Thi, est Thinnest tlBags Thickest Thinnest 4Bags 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 z 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 2060 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 1 � Ire, 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.socehd.com <br />