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SAN JOAQUIN <br /> Environmental Health Department <br /> Zal —COUNTY... . <br /> cScuoaw,' Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /�2 y/! Inspector: Nay"` CONSTRUCTION <br /> Facility Address: -<It., ap'uN- C <br /> Well Address:e _ Total Depth: <br /> WP# Utz x'714/ Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> $ <br /> Min 2"Annular EHD Seal Verified: El Yes 11 No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: A-0ZW'4K <br /> Consultant: r,,,al&ee -*4-e Filter Pack From: To: <br /> Geologist:_&OC Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLPTION COMP EnON <br /> Method: Ground SLr1=' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —`--n' <br /> ft. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: stoned = <br /> a*Cson — B <br /> Covered: ❑ Yes ❑No = S, <br /> Pack <br /> If yes, material: :? <br /> t �< <br /> GROUTING or DESTRUCTION Total Depth: SO ' <br /> Depth to Water: <br /> n. <br /> Grout Material: i1Al'lll/ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation LKBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> Q�,pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity [QTremie ❑Other: Type of Method: <br /> ater Alfement 4 Water Cement 94 lb <br /> gallon s allons Bags <br /> Thick Thinnest J:Bags Thickest Thinnest bBags Bentonite/Cement Mix 3% Mix 55% 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 1 8 <br /> I/- 18 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s6cehd.com <br />