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2 SKJOAHIN <br />—COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />/ Monitoring Well/Soil Boring Inspection Report <br />Date: ! ZI Inspector: WCONSTRUCTION <br />Facility Address: / 0 <br />Well Addres : , Total Depth: <br />WP# M Well#: Drilling Rig Type: <br />Soil Boring#:rs 74? l '-:PMin 2" Annular EHD Seal Verified: <br />Drilling Company: <br />❑ Yes ❑No <br />Driller Onsite: Y–,% e=o Jr" 41 � (pi Screen Length From: To: <br />Consultant: G ICUA Filter Pack From: To: <br />Geologist: �,r 'i Zv Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes ❑No ]B Z <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes L1 No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />'Boring Installation El Boring Destruction <br />METHOD USED <br />pure GroBriLL__ <br />rZ Gravit)yremie ❑Othe . <br />g6 <br />Water <br />gall] s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />kBags <br />Thickest Thinnest <br />4Bags <br />2.5 5 <br />1 <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 />110 COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRM'rY 3OX <br />COMPLETION COMPLETION <br />Ground surface .-+ •� <br />grout <br />n. <br />tt. <br />= a <br />— a <br />slonad —c <br />sac7on — B <br />9-71 Irk <br />MATERIALS/DEVELOPM ENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite Der 94 Ib 2.82 4.7 <br />VA4 <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.secehd.com <br />