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SAN J UAQ U I N Environmental Health Department <br /> fem :< <br /> COUNTY <br /> grows rows here . <br /> ?cir- og ' <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : � � , � z2 Inspector : r CONSTRUCTION <br /> Facility Address : Y1 ' 57 �-- <br /> Well Address . Total Depth : <br /> W P # � Well # : Drilling Rig Type : <br /> Soil Boring# : Min 2 " Annular EHD Seal Verified : ❑ Yes El No <br /> Drilling Company : Relj7ec—ete <br /> Driller Onsite : <br /> Screen Length From : To : <br /> Consultant : hyy� 61M <br /> Filter Pack From . To : <br /> Geologist : 04%,.,,` a <br /> 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 casing <br /> If yes , location and distance : height <br /> SAMPLING ABovE..GAourto __ <br /> Holding Temperature : CONFLETCN CC+ APLET1oN <br /> Method : Gmrjd S "ris" <br /> Screening Method : cr«n <br /> Verified Chain of Custody : ❑ Yes El No ft' <br /> ft. <br /> ft. <br /> SPOILS — <br /> At <br /> Contamination Noted . ❑ Yes ❑ No <br /> If yes , spoils storage Location : <br /> aeon <br /> Covered : ❑ Yes ❑ No <br /> gravel pack <br /> If yes , material . <br /> Ji[ . <br /> GROUTING or DESTRUCTION Total Depth . <br /> tt. <br /> Depth to Water : Z 0j tt- <br /> Grout Material : /►�� c,�ivc�`� <br /> Gallons of Grout Used : / 3e) �gl/c- r MATERIALS / DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation Well Destruction Blank Feet Screen Feet <br /> ElBoring Installation ElBoring Destruction Slot Size : <br /> Bags of Cement . <br /> METHOD USED Bags Sand / Gravel . <br /> Type/ Brand of Bentonite : <br /> El Pressure Grout ❑ Over Drill Filter Pack Type/Size : <br /> ❑ Gravity Eiremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest Bags Thickest Thinnest # Bags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> Ott <br /> 2 . 5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> 5 10 2 10 20 2 Bentonite per $4 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 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/ 16/2017 <br />