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"c. SAKJOAOUIN <br />Environmental Health Department <br />�`� —COUNTY -- <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2" �r _ Inspector:( <br />Facility Address: 30660 (1(1(' w MU'cu M <br />Well Address: <br />W P# Well#: <br />Soil Boring#: SCS SGPOI <br />Drilling Company: 6 C [?r i I I iy'01 <br />Driller Onsite: 0,57'n't0 <br />Consultant: -I v 'h <br />Geologist: <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />LIIAL1d!]111110re <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes 11 No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND C-HRZTY43OX <br />COMPLETION COMPLETION <br />Ground sk�tx. ZSc� fu� <br />1577, grout <br />VA <br />CIO <br />U <br />Slotted <br />section <br />_ = prawt pads <br />GROUTING or DESTRUCTION Total Depth: 5 �Z _ <br />Depth to Water: %'1p .r , n' n' <br />Grout Material: MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: v0 n . <br />Casing Type: <br />❑Well Installation Well Destruction Blank Feet <br />J 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 />❑ Gravity ❑Tremie ❑Other: Type of Method: <br />Water <br />allons <br />ent 471b <br />Bas <br />Water <br />gallans <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />uBags <br />Thickest Thinnest <br />Jt Bags <br />2.5 5 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 3% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.smcehd.com <br />