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-_; $ANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> ,,,,, Greatness brows 1wr,. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: �)Odl <br /> In CONSTRUCTION <br /> Facility Address: / <br /> Well Address: Total Depth: <br /> WP#* 2q bblDO _Well#: Drilling Rig Type: <br /> Soil Boring#: 1•/lV1) <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 1 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes,location and distance: M height <br /> _EWT <br /> SAMPLING ABOVE-GROUND <br /> CONFsLETIDN C}1RISTY-eOx <br /> Holding Temperature: cornriEmoN <br /> Method: Gmnd S xlac0 <br /> Screening Method: arcut <br /> Verified Chain of Custody: ❑ Yes ❑No —h <br /> tt. <br /> SPOILS <br /> i <br /> e <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: awned <br /> aac:on — 8 <br /> Covered: ❑ Yes ❑No <br /> graw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 2,72 <br /> Depth to Water: tt• — n <br /> Grout Material: Mimi- rhlyo�� <br /> Gallons of Grout Used: "%-, MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation OWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> 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 ❑Tremie ❑Other: Type of Method: <br /> Water ment 471b j Water cement 94lb <br /> allons Ba s eallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> z5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 1a 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 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 6 <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 />