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SAN JOAOUIN <br /> Environmental Health Department <br /> --COUNTY---- <br /> Greatness <br /> —COUNTY-- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 31�G��� Inspector:- CONSTRUCTION <br /> Facility Address: y(ev0 E• 4cav+>c /2 <br /> Well Address: Total Depth: <br /> WP# e1v-3 Z-// q Well#: Drilling Rig Type: r <br /> Soil Boring#: G / 2 3 <br /> i �cee� �� Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: 'n �/ <br /> _ Screen Length From: To: <br /> Driller Onsite: 74ro? <br /> Consultant: Filter Pack From: To: <br /> Geologist: <br /> 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 CHR__ <br /> Holding Temperature: COWLETION compl EnoN <br /> Method: Ground Surfacs <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No <br /> it. <br /> tt. <br /> SPOILS �pT sem, <br /> ' — o <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slaved = . <br /> soon _ B <br /> Covered: ❑ Yes ❑No G Ste, : _ g Pack <br /> If yes, material: �Y '? <br /> GROUTING or DESTRUCTION Total Depth: C5 <br /> Depth to Water: z3' n• n' <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation IRBoring Destruction <br /> 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 ®Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest zBags 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 / p <br /> 15 30 6 30 60 6 �K f`b �7 4('7 !7 ! r� �,,,f'!ZL'L/0. <br /> 17.5 35 7 35 70 7 (141"51 <br /> 20 40 8 40 80 8 Z 0 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.s*cehd.com <br />