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SAN. J OA Q U I N Environmental Health Department <br /> —COUNTY— <br /> Monitoring Well/Soil Boring Inspection Report <br /> q,Date: Z'�j11QJ Inspector: V AYI(& W oinll CONSTRUCTION <br /> Facility Address: 5(oe)5 G. U)0991*610M M <br /> t�INell Address: f carAyc) CA Total Depth: Z210 ,,� <br /> WP# 001791--( Well#: Drilling Rig Type:_ V\jcA ' -C �aVC <br /> Soil Boring#: Ili <br /> Drilling Company: k+pf C-�roSS <br /> Dn\\\r\cq Min 2" Annular EHD Seal Verified: JK Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: �P�1'�1 rgif0515 - see <br /> Consultant: Filter Pack From: To: <br /> Geologist: _ Bentonite From: To: <br /> Grout From: a(,c, To: q <br /> Public Water System Onsite: ❑ Yes ♦—No COMPLETION ❑ Stove Pipe I ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes FNo casing �v <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETIOtJ COMPtE71oN <br /> Method: °`°`"'ds`sf"' <br /> Screening Meth grout <br /> Verified ain of Custody: ❑ Yes ❑No ft' <br /> ft. <br /> fi. <br /> SPOILS r: <br /> Contamination Noted: L1 Yes El No <br /> If yes,spoils sto ge Location: slottard <br /> sacCon :.. — <br /> Covered: ❑ Yes ❑No <br /> If s, material: 1 <br /> ROUTIN r Total Depth: Y. = <br /> Depth to Water: R n' tt' <br /> Grout Material: 0-J <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: PGI(AlC <br /> .Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: W�\� D <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: CP G,l 3 s• <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas Rallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 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 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />