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Environmental Health Department <br /> Greotnass grows here. <br /> 2 Monitoring Well/Soil Boring Inspection Report <br /> Date: �2 �2 23 Inspector: 564 l S CONSTRUCTION <br /> Facility Address; t <br /> Well Address: Total Depth: <br /> WP#.d-c_L97()GA Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: <br /> Driller Onsite; 0i' . Screen Length From; To: <br /> Consultant: �-S_ V i Pack From: To: <br /> Geologist: e�—ma4A entonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe [ Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes, location and distance: h� g � <br /> SAMPLING <br /> I:B�JVE-i�£Rfx ND <br /> Holding Temperature: <br /> �1P1;=71QN <br /> Method: r�«irasurraca-�---�-y--�--�^ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Noit• <br /> SPOILS <br /> ti. <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: s <br /> atattad �s •� � <br /> sseann 7� <br /> Covered: ❑ Yes ❑No — > <br /> If yes,material: <br /> GROUTING-or-DESTRUCTION. Total Depth:__. <br /> Depth to Water: • '" " • <br /> Grout Material:_ (-PAAO MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation l Nell Destruction 00-' Blank Feet Screen Feet <br /> ❑ PBoring Installation ❑ ��A Slot Size: <br /> Boring Destruction ��Y�� pp �� Bags of Cement: <br /> METHOD USED CX�'���� Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> Pressure Grout ❑Over Drill S _ t�,1 Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: A Type of Method: <br /> Water Cement 471b Water Cement 941b , <br /> gallons Bags gallons Ba s <br /> Thickest Thinnest 8Bags Thickest Thinnest HBags Sent;Qnit;elCement 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 80 8 <br /> 10 20 4 20 40 4 <br /> 12,5 25 5 25 50 5 <br /> 15 8o 6 30 60 6 <br /> 1715 85 7 35 70 7 <br /> 20 40 8 40 80 8 ' <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138.1 www.slcehd.com <br />