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SAN 10AQUIN Environmental Health Department <br /> Jr.1TV <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2to 10 Inspector: L-7- � CONSTRUCTION <br /> Premise Address: -13571 &.."A L.� <br /> WP#: c9J?'11 y"L'1 Total Depth: <br /> Well#: Drilling Rig Type: <br /> Soil Boring#: CPT PTH 'CersGPT(e,L'�� <br /> Drillin Com any: v Min 2" Annular Seal Verified: ❑ Yes El No <br /> g p �L.�l C wT�1 7-Sao-4�os�p-�c. <br /> Driller Onsite: X511 Screen Length From: To: <br /> Consultant: <br /> Filter Pack From: To: <br /> Geologist: �1 Bentonite From: To: <br /> g (`J�w <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 AVE-GROUNO C�HR__ <br /> Holding Temperature: CONFL T;ON CC#AP=CN <br /> Method: Gmnd Surf acs '+ <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> fi. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slcttad <br /> &*cion — B <br /> Covered: ❑ Yes ❑No = k <br /> If yes, material: a <br /> GROUTING or DESTRUCTION Total Depth: a,6s i-so kL- =0'�i Zo0'., <br /> Depth to Water.^Vt n- n' <br /> Grout Material: ✓ ,c.Js- Ct <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:-SF-- <br /> 3! Casing Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ���� Slot Size: <br /> ❑Boring Installation M•Boring Destruction 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 R remie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest AlBags Thickest Thinnest 4Bags <br /> 2.5 5 1 5 10 1 Bentonite/Cement Mix 3% Mix 5% Mix <br /> 5 10 2 10 20 2 Bentonite per 47 Ib 1.41 2.47 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 Bentonite per 94 Ib 2.82 4.7 <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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />