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/DUAN S Environmental Health Department <br /> —COUNTY <br /> 0 Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Q'28"2�`C1 Inspector: Carol prem CONSTRUCTION <br /> Facility Address: BV?rIphrg+ <br /> Well Address: Total Depth: <br /> WP#QO41 12-01Z Well#: Drilling Rig Type: <br /> Soil Boring#: CPT -0 , CpT • I <br /> Drilling Company: CQ0 FX Svb�1i{gcQ ExpldrQ11c7n Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: 9110171Screen Length From: To: <br /> Consultant: 0110it-T14 IN 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 /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION comPLEnoN <br /> Method: Ground Swfaos <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft• <br /> it. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes, spoils storage Location: .bnea B <br /> aeon <br /> Covered: ❑ Yes ❑No = g,,,e,Pack <br /> If yes, material: _= <br /> GROUTING or DESTRUCTION Total Depth:VX) <br /> Depth to Water: 14 n• tt. <br /> Grout Material: NQQt CQInQn't <br /> Gallons of Grout Used: � MATERIALS/DEVELOPMENT <br /> ')-d <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Aoring 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 /> ❑ Gravity dTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest It Bags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 s 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 2 x yj ID nags of CQMQ tt <br /> 12.5 25 5 25 50 5 <br /> is 30 6 30 60 6 G ggl►Grls �YQtQr GpT- l} <br /> 17.5 35 7 35 70 7 <br /> 20 40 s 40 e0 e 3 < y1 Ib bU S v covat' <br /> q CPT- Iq 10/16/2017 <br /> 12 qQ I Ia Y1 S VW-Nr r <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 />