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` �2�° u� g SA 10AQUIN <br /> E "/ Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:cl/O/N InspectorA,.LeG`f CONSTRUCTION <br /> Facility Address: 5 o 3 w. 16eti Vt F <br /> Well Address: Total Depth: <br /> WP# 'Lyootmi Well#: Drilling Rig Type: <br /> Soil Boring#: 1QIQA 4Of fit ON <br /> Drilling Company: k � Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: J Screen Length From: To: <br /> u Filter Pack From: To: <br /> Consultant: <br /> Geologist: mat C k Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No --rr-- casing <br /> If yes, location and distance: height <br /> SAMPLING Mi;VE-GROUND <br /> Holding Temperature: C06PLET{ON COMP=CN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> ft. <br /> ft. <br /> SPOILS <br /> = o <br /> Contamination Noted: ❑ Yes El No — r <br /> If yes, spoils storage Location: stottQd <br /> soccon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: 'x <br /> GROUTING or DESTRUCTION Total Depth:T� t;S' <br /> Depth to Water: l$ i n• <br /> tt. <br /> Grout Material: t/ICc4J­C-&&-0 <br /> Gallons of Grout Used: 2Y k t MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 1�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 EjTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bags gallons Bags <br /> Thickest Thinnest tlBags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% 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 Ot 16CvE, L ,&-e bij�� C A,- CC.L."..4 t y <br /> 15 30 6 30 60 6 i C <br /> 17.5 35 7 35 70 7 r, Cj J t c, t c4 G,Ae �r, Lv 1 <br /> 20 40 8 40 80 8 <br /> NouyS L.tLC'vl 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />