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0�-u"z SANAMIN <br /> Environmental Health Department <br /> --COU NTY- <br /> Greatness grows here. <br /> Monitoring/Well/Soil Boring Inspection Report <br /> Date: /*70V Inspector: N-7'a TJ CONSTRUCTION <br /> Facility Address: O �{ g (� 5 <br /> Well Address: Total Depth: S —50 y <br /> WP# C7 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: I ` <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: rj4qAAqo> IK Filter Pack From: To: <br /> Geologist: T 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: 37 <br /> height <br /> SAMPLING ABOVE-GRCUN0 <br /> Holding Temperature: COWLETION �CMPP EnoN <br /> Method: G=nd Suf'ct <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt. <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r" <br /> If yes, spoils storage Location: abt:ad <br /> 4 = <br /> soon — <br /> Covered: ❑ Yes ❑Noa _ V'W <br /> Pack <br /> If yes, material: <br /> S D <br /> GROUTING or DESTRUCTION Total Depth: 4'-4 __ <br /> Depth to Water: tj{ ti. — Jt. <br /> Grout Material: <br /> Gallons of Grout Used: Q o- MATERIALS/DEVELOPMENT <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 /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 0 Gravity 14Tremie ❑Other: Type of Method: <br /> Water Cement 47Ib Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest uBags 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 1 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. �azelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />