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01" SANc,)QAQQIN Environme...al Health Department <br /> ,. <br /> ' <br /> I; i�t; .; ) —COUNTY— <br /> •\ s"� Greatness grows here. <br /> 4F04• <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: IV3 Inspector: CONSTRUCTION <br /> Facility Address:%C` g) t 22 <br /> Weil Address: Total Depth: <br /> WP# LI� Well#: w�--_ Drilling Rig Type: <br /> Soil Boring#: Nl A Min 2"Annular EHD Seal Verified: ❑Yes ONO <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: 4M� Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist: A Grout From: To: <br /> Public Water System Onsite: ❑ Yes `lo COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic WellOnsite: Yes ONO casghting <br /> hei <br /> If yes,location and distance <br /> SAMPLING ABOVEGROUND crtntmeox <br /> 00PPLE ION COMPLETION <br /> Holding Temperature: Glotlna s:w <br /> Method: grcut <br /> Screening Method: <br /> Verified Chain of custody: ❑ Yes ONO H. <br /> SPOILS = - <br /> Contamination Noted: ❑Yes ❑No y a <br /> If yes,spoils storage Location: section•bc — A <br /> Covered: ❑Yes []No gnvw Pack <br /> If yes, material: B <br /> GROUTING or DESTRUCTION1Total Depth:Sb tt = tt, <br /> Depth to Water: <br /> Grout Material: '^C \ MAMATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: <br /> ❑ Gravity VV�Tremie ❑Other: <br /> Type of Method: <br /> Water Cement 4711) Water cement 941b <br /> allons Be s lions Ba <br /> Thickest Thinnest Bags <br /> BentonitelCement Mix 3% Mix 5%J��477 <br /> Thickest Thinnest Heats Bentoneper2.551s 1B 1 282 <br /> 5 10 2 10 20 2 lElentonile per 94 Ib <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 1s 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 a 40 B0 B 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 />