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SAN )UAQUIN Environmental Health Department <br /> " ! �' COUNTY <br /> Greotness grows he, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: � 'LZ tz Inspector: ,Ase6pt CONSTRUCTION <br /> Facility Address: 30` Q <br /> Well Address: Total Depth: <br /> W P#()o N33 z Well#: Drilling Rig Type: <br /> Soil Boring#: 2 F-Lt -ooty Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> .+ <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant:_,-/11 Krol t Filter Pack From: To: <br /> Geologist: �'Q� 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 cas'rg <br /> If yes, location and distance: 7 height <br /> SAMPLING ABOVE-GRCUND <br /> Holding Temperature: OOWu-`T1ON e-W�mN <br /> Method: Cvwnd sL;rtx. <br /> Screening Method: erg <br /> Verified Chain of Custody: ❑ Yes ❑No �tt. <br /> ft. <br /> tt. <br /> SPOILS — <br /> a <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: <br /> a -cn <br /> Covered: ❑ Yes ❑No = 1Ld <br /> If yes, material: ;+ <br /> GROUTING or DESTRUCTION Total Depth: �(O- <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: AIxj 71 ;:erlc- MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> ��// Filter Pack Type/Size: <br /> El Gravity UTremie ❑Other: Type of Method: <br /> water Cement 471b Water Cement 441b <br /> allon< Bagsallons Ba s <br /> Thickest Thinnest "Bags Th ckest Thinnest ABag> <br /> Bentonite/Cement Mix 3% Mix 3% Mix <br /> 25 5 1 5 w 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 Bentonite per 94 Ib 2.82 4.7 <br /> 75 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12 5 25 25 50 5 <br /> 1` 30 1 6 30 60 6 <br /> 17.5 35 1 7 35 70 7 <br /> iC 40 I S 40 90 t' <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.slcehd.com <br />