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JAN.,o1UAQUIN <br /> —COUNTY— Environmental Health Department <br /> �-34 Greo'tness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 71/12q Inspector: "�O"� CONSTRUCTION <br /> Facility Address; &02 A/. tnul�iiy,Qc$ <br /> Well Address: Total Depth: <br /> WP#_ �0 O 3$ ^Weil#: Drilling Riglypec <br /> Sail Boring#:Drilling Company: T6427 Min 2"Annular EHD Seal Verified: ❑Yes []No <br /> DrillerOnsite: Screen Length From: To: <br /> Consultant: 67r0+n.`0l 11-4-rw Filter•Pack From: To; <br /> Geologist; R 44 Bentonite From: To: <br /> Grout From: . To: <br /> Public Water System Onsite: ❑Yes 17No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well onsite: []Yes []No aaelng <br /> If yes,location and distance: nesgtat ' <br /> I n1l <br /> SAMPLING naou �aouNo <br /> Holding Temperature: cnMi'Lru�rl rtutlslYeox <br /> COMPI.6Ti0N <br /> Method: f4cotisxl Swrxa�::..�.. <br /> Screening Method: stool <br /> Verified Chain of Custody: ❑Yes ❑Noll. <br /> SPOILS <br /> ^_ <br /> Contamination Noted: ❑Yes ❑No K <br /> .= q . <br /> aiD <br /> If yes,spoils storage Location: a�staa -s <br /> sascan "" -R <br /> Covered: []Yes ❑No <br /> graval Pack <br /> If yes,material: s <br /> 7 <br /> GROUTING.or-DESTRUCTION.Total Depth:•��/ ",r <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used; N 1 O Caain gType: <br /> E]Well Installation E]Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size:•Boring installation J�Boring Destruction Bags of Cement: <br /> MET140D USED Bags Sand/Gravel; <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity OTremle ❑Other: Type of Method: <br /> Water cement 47lb Water Cement 94Ib <br /> a Ions Ba gallons Bags ' <br /> I. Thinnest #eggs Thlekest Thinnest #Bags OentanitelCement Mix 3% Mix 5!a Mix <br /> 5 1 s 10 1 Rahloniie per 47 ib 1.41 2.47 10 2 10 13 2 Demonite per 94Ib 2.82 4.7 <br /> 15 a 15 8o 3 , s <br /> 20 4 2a 40 4 25 5 25 so 5 30 6. 30 60 6 35 40 0 40 80 e � s 1 <br /> 10/16/2017 <br /> 1868 E.Hazelton Avenue j Stockton, C lifornia 96206 j T 209 468-3420 1 F 209 464-0138-j www.slcehd.com <br />