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�a SAWMAQUIN <br /> •.; �� � • Environmental Health Department <br /> —COUNTY— <br /> Greatness <br /> Greatness grows dere. <br /> 1 Monitoring Well/Soil Boring Inspection Report <br /> Date: l3' Inspector: &Vfpellwr� CONSTRUCTION <br /> Facility dress: �tv I utf,cA Lik <br /> Well Address: A w.��,� L _ Total Depth: <br /> WP# 4-Lk Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: (,(,iy LG% � Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: A-t(i Filter Pack From: To: <br /> Sdyr <br /> Geologist: :5i7V`V, <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ?lo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes �IO casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: GONFLETtON cccm tEnerXi <br /> Method: Ground sumacs ' + <br /> Screening Method: Rt E71, grout <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes No <br /> If yes, spoils storage Location: <br /> sac.onEFE <br /> _• "— <br /> Covered: ❑ Yes El No = „ <br /> ol Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: � t7 <br /> Grout Material: <br /> Gallons of Grout Used: '- 1 -7 ��� cntiS MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation 6well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity )Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags Bentonite/Gement Mix 3% Mix 5% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 11135 70 7 <br /> 20 40 8 40 80 8 <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.socehd.com <br />