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SA N )OAQ U I N Environmental Health Department <br /> COUNTY <br /> T&5 e Wore: <br /> Monitoring Well/Soil Boring Inspection Repor�2 wos o my <br /> Date. 2� Inspector:�Iifla CONSTRUCTION ,p�sehf- Q'o�( , dJ1rOt1'E'� <br /> Facility Address: 11JntbrjUQ d� � �rsl� d�lo. <br /> Well Address: Total Depth: <br /> WP# 160I464 Well#: Drilling Rig Type: <br /> Wig#: Kw 10 . 11 �2 Twill <br /> Drilling Company: Gh ik e <br /> Min 2 Annular EHD Seal Verified: ❑ Yes ❑No ��t� <br /> Driller Onsite: Screen Length From: To: p��c <br /> Consultant: e4w,"r Filter Pack From: To: 7 <br /> Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑Nod• <br /> casing <br /> If yes, location and distance: height urrlved <br /> -awSAMPLING ABOVE-GIRCUND <br /> Holding Temperature: COMPLEnON coti+ iFncN � N`C� <br /> Method: c;round surtact w&s Ajkd <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —`--n' Ord <br /> n. ate- I <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = m l WG.S 0.f,CA pim-5e tf <br /> If yes, spoils storage Location: .totmd _ W hen *,&,I wee' <br /> action y — -l�i�d� '`�• <br /> Covered: El Yes ❑No = s-v+pack <br /> If yes, material: <br /> Tp C-7w. <br /> GROUTING or DESTRUCTION Total Depth: 161 ,_1U09� 66 w <br /> Depth to Water: �).t{ . 30• t. �.11 ft. n. f0f 0M *3 <br /> Grout Material: tle Cup—ri&t� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �. V-2. <br /> J Casing Type: <br /> ❑Well Installation Nell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> XrPressure Grout []Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity >fremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall Bags qallons Bags <br /> Thickest Thinnest HBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />