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f SAN '�DQQU I N <br /> a' Environmental Health Department <br /> L.: —COU NTY— <br /> `Sr, a ` Greatness grows here. <br /> �y 7 Monitoring Well/Soil Boring Inspection Report <br /> Date: 6 /C-� Ins�p_�jctor: V" �'r CONSTRUCTION <br /> Facility Address: 2 `� � <br /> Well Address:., ( Vi ll S Total Depth. �J <br /> WP# 00 �'�7 Well#:-S--tA ff-Jed �3§�illing Rig Type: <br /> Soil Boring#: &C7D <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: V\C)e— Screen Length From: To: <br /> Consultant: L Qn &f- r Filter Pack From: To: <br /> Geologist: 1 0. t' Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: COMF'LEi10N comPLEngN <br /> Method: around Saff'c' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r' <br /> C <br /> If yes, spoils storage Location: ��I = s <br /> sacdon nad i' = 3 <br /> Covered: ❑ Yes ❑No <br /> pray.tpack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 30 <br /> Depth to Water wIA .0'vlc- <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Nell Destruction Blank Feet Screen Feet <br /> / \ Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> A� ) Type/Brand of Bentonite: <br /> essure Gro;er <br /> er Drill Filter Pack Type/Size: <br /> ❑ Gravity mie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> gall s Bags eall s Bags <br /> Thickest Thinnest #Bags 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 2S 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 8 <br /> P � .ki 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 www.socehd.com <br />