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SANAOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: lev?-VA Inspe tor: ' CONSTRUCTION <br /> Facility Address:�a-` <br /> Well�ddress ✓ d w- o-IIP�/ Total Depth: <br /> WP&Li (9k Well#:.SV9- 0 / Drilling Rig Type: <br /> Soil Boring#: C� <br /> Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes []No <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 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: CO�"FLETION COMPLETION <br /> Method: Ground S"}"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �.ft. <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes,spoils storage Location: abned <br /> on = B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: 5 <br /> GROUTING or DESTRUCTION Total Depth: - 7 5-f4 <br /> Depth to Water: r- n- n' <br /> Grout Material: <br /> Gallons of Grout Used: /�-3 S� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Over Drill Filter Pack Type/Size: <br /> �.11., <br /> El Gravity Tr mi ❑Other: Type of Method: <br /> Water Cemen 71b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest ttBags 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 /> S 6 o, S 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />