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SAN J OA Q U I N Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> o� Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 2 1 Inspector• EU0 r'e'0-f CONSTRUCTION <br /> Facility Addre : 1105 tdv\ Sl w*c cot <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: T - Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Compan : • OY�G 'W �(�(, _ <br /> Driller Onsite: 05 Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: nivu 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 <br /> casing <br /> If yes, location and distance: height <br /> WT 7erW7T7 <br /> SAMPLING a.sov;=-GRCUND <br /> coWLI=nor COMPLY-aox <br /> Holding Temperature: oo�,>.J=rioN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No L�ft- <br /> ft. <br /> fi. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: stottad <br /> sac�on = <br /> Covered: ❑ Yes ❑No <br /> g-4 pacK <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:61-2Q7t g2-t)/. 5-ft- <br /> Depth to Water: - 21. — tt <br /> Grout Material: N 1 Q d MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 7413oring Destruction gags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> C�Gravity �Tremie ❑Other: Type of Method: <br /> (( Water Cement 471b Water Cement 941b <br /> allons Bags gall ons Bags <br /> Thickest Thinnest kBags Thickest Thinnest tJBags 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 I �gWw\ <br /> 12.5 25 5 25 50 5 — 3 C-1 L 16� l C�� <br /> 15 30 6 30 60 6 (((���J <br /> 35 7 35 70 7 <br /> 20 6sJ\ + G�7l w <br /> 20 40 8 40 80 8 p <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />