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4 ' SAN OQQ N Environmental Health Department <br /> COUNTY <br /> Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : �) lZ Zl Inspector : r>fs c'-t-1*"` CONSTRUCTION <br /> Facility Address : <br /> Well Address : Total Depth : <br /> WP # w � Well # : MOH I rjt14/ ' Z Drilling Rig Type : <br /> Soil Boring# : <br /> Min 2" Annular EHD Seal Verified : 11 Yes [] No <br /> Drilling Company : r=)w14�) 77 Zz, L <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 [I No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No casing <br /> If yes, location and distance : height <br /> SAMPLING ABOVE GROUND <br /> Holding Temperature : COWLETION COMPLEoN <br /> Method : Ground SmIaas <br /> Screening Method : INgrcxA <br /> Verified Chain of Custody : ❑ Yes ❑ No � tt. <br /> tt. <br /> tt . <br /> SPOILS = <br /> _ a <br /> Contamination Noted : ❑ Yes ❑ No <br /> If yes , spoils storage Location : � to � <br /> Covered : 1:1 Yes El No mon <br /> Hyl,.✓ - Z : �S r; _ Vayst pack <br /> If yes , material : <br /> GROUTING or DESTRUCTION Total Depth : — <br /> Depth to Water : jAjb tt. <br /> Grout Material : /d/��-• � �s'"� <br /> MATERIALS/ DEVELOPMENT <br /> Gallons of Grout Used : �MV 5 , / c/o� Casing Type : <br /> ❑ Well Installation PKNell Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation ❑ Slot Size : <br /> Boring Destruction gags Size : <br /> Cement : <br /> METHOD USED Bags Sand/Gravel : <br /> ❑ Pressure Grout ❑ Over Drill Type/ Brand of Bentonite : <br /> ,_,.// Filter Pack Type/Size : <br /> ❑ Gravity E! Tremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izallons EK Ba s <br /> Thickest Thinnest 9Bags Thickest Thinnest Bags Bentonite/Gement Mix 3 % Mix 5 % MIX <br /> Is 5 1 5 i ) 10 1 Bentonite per 47 Ib 1411 2 .47 <br /> s to z 10 20 Bentonite per 94 Ib 20821 4 . 7 <br /> 7. 5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12. 5 25 1 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 /> be r5 10/ 16/2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468- 3420 F 209 464-0138 www . sicehd . com <br />