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G!.'v <br /> )L1 t <br /> .= SAN lOAQUIti Environmental Health Department <br /> —COUNTY— <br /> O< _ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: + / 3 lZo Inspe tor: v" CONSTRUCTION <br /> Facility Address: 7 < <br /> Well Address: Total Depth:. <br /> WP# a G Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: ,'— <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 4f 4LL Filter Pack From: To: <br /> Geologist: Zc Bentonite 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: height <br /> SAMPLING AWVE-GROUND _ <br /> Holding Temperature: COWPLE ION MN <br /> Method: Ground Sudact '—' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> ft. <br /> SPOILS yyr <br /> ,AFAR <br /> Contamination Noted: ❑ Yes ❑No r' = <br /> If yes, spoils storage Location: stoned <br /> Covered: ElYes El No men <br /> _ pravot pack <br /> If yes, material: Li <br /> GROUTING or DESTRUCTION Total Depth: N, <br /> Depth to Water: �n �'V1(W^^� n- n- <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation OWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED N�' ; �' pM� 1 9 cun�2i' Bags Sand/Gravel: <br /> tka, s � cmc" Type/Brand of Bentonite: <br /> ❑Pressure Grout ver Drill I ¢ r N tic � oMj V4,VJ <br /> � s to 5', 4O0��n Filter Pack Type/:Size: <br /> El Gravity [Xremie ❑Other: � Type of Method: <br /> being stuck cil- tosus ,,Luy_,r- a_S <br /> Water Cement 47lb Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 s 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 II- <br /> 1zs 2s s zs so s �p nV� G it A.,1L 5 h0 <br /> is 30 6 30 60 6 <br /> 35 7 35 70 7 20 <br /> 20 40 8 40 80 8 <br /> `Ll.�� S 35 ,-t0 3 T oLud �o K1ell 10 10/16/2017 <br /> 1868 E. Haze ltoj4venue I Stockton, Califor,is 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />