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SAN',;10A0UIN <br /> Environmental Health Department <br /> 19 . <br /> —COUNTY— <br /> Cts Feer Creotness grolvs Were. <br /> ��11 <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:i2- z� qno Inspector: L l 6t CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# O Well#: Drilling Rig Type: <br /> Soil Boring#: 6 4' Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: �r <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 [I No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> 7 <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLE ION CCOMP�LE7nOON <br /> Method: Ground Surface <br /> Screening Method: Bron <br /> Verified Chain of Custody: ❑ Yes El No <br /> fi. <br /> tt. <br /> SPOILS <br /> sv = o <br /> Contamination Noted: ❑ Yes El No r <br /> If yes,spoils storage Location: lf <br /> saction y <br /> Covered: ❑ Yes ❑No .= gra rtek <br /> If yes, material: <br /> =-V <br /> GROUTING or DESTRUCTION Total Depth: <br /> IF <br /> Depth to Water: N I <br /> Grout Material:— Y^r)vcft <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> LGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Basgallons Bags <br /> 7i,ickea Thinnest 4'Bags lhick�=_st hirer->st. Bag; Bentonitelcetnent Mix 3% Mix ri% Mix <br /> 2.55 lu i benionito per 41 Ib 1.4'1 2.4/ <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />