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��°"°= c° SAN)J0A0UIN <br /> A..Zj; —COUNTY— Environmental Health Department <br /> erF6a�' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: W'WI-ago Inspector: 4�IoLt nGt.J CONSTRUCTION <br /> Facility Address:—2,!B500 � 5(:x'1 - <br /> Well Address: Total Depth: <br /> WP#-Qq�►+� , Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: -y`,J � �� � Min 2"Annular EHD Seal Verified: L1 Yes L1 No <br /> Driller Onsite: - � Screen Length From: To: <br /> gyp= •; Filter Pack From: To: <br /> Consultant: <br /> Geologist: . <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes L1 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND C.HR_ <br /> Holding Temperature: COMPLETION COMPLEnON <br /> Method: Ground Surface <br /> Screening Method: ar«^ <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: atoned = . <br /> aocton — <br /> Covered: ❑ Yes ❑Nogravel> <br /> ack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: lO <br /> Depth to Water: IOVt" <br /> Grout Material: t" <br /> 2 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction If, "3 ww�• Blank Feet Screen Feet <br /> ❑ ���� � C Boring Installation�z9Boring Destruction Slot Size:Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest >rBags Thickest Thinnest tlBags 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 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 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 />