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SAN J OAQ U I N Environmental Health Department <br /> -- COUNTY <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 11 4Ili( Inspector: AJA 96E*4"*- CONSTRUCTION /-20 <br /> Facility Address:_Ito7 Ryde_ Ane Zo S2'" 'S 7/jr ��� <br /> Well Address: Total Depth: NwA��1 ar�� <br /> WP#_cod qb 6ll Well#: Drilling Rig Type: —� <br /> Soil Boring#: BI Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company:—P1-7444e la's tlr N� Co Screen Length From: To: <br /> Driller Onsite: Tarw i S <br /> Consultant: Filter Pack From: To: <br /> Geologist: DAn1 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWt.ETION C4WPLE77oN <br /> Method: G=ndd SLe=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No eft' <br /> ft. <br /> tt. <br /> SPOILS = <br /> = o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted _ - B <br /> aac�on ' <br /> Covered: ❑ Yes 1:1 No = prswlpacic <br /> If yes, material: <br /> R <br /> GROUTING or DESTRUCTION Total Depth: =_ <br /> Depth to Water: 1 ,t it. tt. <br /> Grout Material: Nfec e'Crwfn <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 'Boring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> [pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity 5LTremie ❑Other: Type of Method: <br /> Wat ement 71b water Cement 94 lb <br /> allons gall ons Bags <br /> Thi ckMt— innest uBags Thickest Thinnest ttBags <br /> Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 35 70 7 <br /> 20 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sbcehd.com <br />