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SAN 10AQUIIV <br /> COUNTY— Environmen al Health Department <br /> =P9tP Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> :�� ZDate "o Ins ector: CONSTRUCTION <br /> Facility Address::ZAK) 6-"h(J6 <br /> Well Address: Total Depth: i if <br /> WP# Well#: �(� Drilling Rig Type: 1 I <br /> Soil Boring#: ,QS! J-vr' t 5k, > Min 2"Annular EHD Verified: ❑ Yes ❑No <br /> Drilling Company: ? 1 vf4 <br /> Driller Onsite: QQScreen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: L � Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No <br /> tea-. casing <br /> If yes, location and distance: S� 1 height <br /> JDI- <br /> _CWT <br /> Y" ♦♦♦ <br /> SAMPLING <br /> ABOVE-GROUND <br /> Holding Temperature: x�`� COAVILET ION CFG9f5TY43OX <br /> coMPLEnON <br /> Method: GroundSurfaae r --5✓ l <br /> Screening Method: ft <br /> 4 Oro`n 7r <br /> Verified Chain of Custody: ❑ Yes ❑No , P. I 's <br /> tt. <br /> SPOILS - —_ <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abttad '' ._ 3 Prn sup <br /> seedon <br /> Covered: ❑ Yes []No = ¢,,,,tom <br /> If yes, material: � srP�� = <br /> GROUTING or DESTRUCTION Total P_epth:� __ Fr4e" <br /> Depth to Water: Z ft. tt <br /> Grout Material: � MATERIALS/DEVELOPMENT -V <br /> Gall ns of Grout Used: 31 <br /> Casing Type: <br /> ell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> ' Bags of Cement: <br /> !'l <br /> METHOD USED �� '� bp �� �� Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> 'X_'�Iravity Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gall ons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest IBags Bentonite/Cement Mix 3% MIX 3%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 952051 T 209 468-34201 F 209 464-0138 1 www.s*cehd.com <br />