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SA6JOAQUIN <br /> ,8P� u Environmental Health Department <br /> COUNTY- <br /> Greotness gro..= <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: inspector: UQ��Q CONSTRUCTION <br /> Facility Address:__Mk �' b <br /> 1 <br /> Well Address: Total Depth: <br /> WP# 'LW Well#:AV\j-Q t �W Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes []NoDrilling Company: VIV1�2DI�V}'lOinfAi Uhl O�a}� <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: N Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: YtT height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLS 1ON comPLELEnON <br /> Method: GroundSurfaoe "' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No -�--n' <br /> ft. <br /> ft. <br /> SPOILS = <br /> e <br /> Contamination Noted: ❑ Yes []No — <br /> If yes, spoils storage Location: atottad <br /> soon <br /> Covered: ❑ Yes ❑No = s <br /> ack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: � x2 =_ <br /> Depth to Water: N n _ ft. <br /> Grout Material: �n <br /> Gallons of Grout Used: J ' ATERIALS DEVELOPMENT <br /> I,�, asing Type: <br /> ❑Well Installation Well Destruction 11 olq �Nlank Feet Screen Feet <br /> WQ�S❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags 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 Aremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags pallons Bags <br /> Thickest Thinnest 4Bags I Thickest Thinnest .1 Bags Bentonite/Cement Mix 3% Mix 55%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />