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SA N J OAQ U I N Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: U�1 Inspector: N14SEEe'1 CONSTRUCTION 31, <br /> Facility Address: Z9Go Eg-9moA4 �1+ <br /> Well Address: Total Depth: <br /> WP# CLQ 3 T 05 q Well#: Drilling Rig Type: <br /> Soil Boring#: 131, z, 3, y, S`,� Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: A'isaz 'q–ao >z' It s <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Z5;&?a' �' Filter Pack From: To: <br /> Geologist: '1,& 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: CO+"F�ION �tr=ncN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �--n" <br /> n. <br /> ft. <br /> SPOILS <br /> 0 <br /> Contamination Noted: ❑ Yes El No 131 +{��� <br /> If yes,spoils storage Location: GZ 1,5' slotted <br /> Covered: 1:1Yes ❑No y <br /> 20` s�cson <br /> If yes, material: 131 1 O <br /> GROUTING or DESTRUCTION Total Depth: '", n <br /> Depth to Water: 17' 969 14 n• tt. <br /> Grout Material:_ "To" tL <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation 5IBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> (3z .b0 $(p Filter Pack Type/Size: <br /> ❑ Gravity Tr ®Other:Flee Eiji Type of Method: <br /> a r Ce 719 Water Cement 94 1b <br /> Ilon a s allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% 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 I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />