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_ SAN,JOAQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> / ^7 a Monitoring Well/Soil Boring Inspection Report <br /> Date: 21711q f 1"1 Inspector: CONSTRUCTION <br /> Facility Address: 360 I Q <br /> Well Address: Total Depth: <br /> WP#_00 Z 22 ft2 S Well#: Drilling Rig Type: <br /> Soil Boring#:- 2-1 . 9-21- 14 0 I�hQ►YI � � Min 2"Annular EHD Seal Verified: ElYes []NoDrilling Company: �CA_16 W <br /> Driller Onsite: e,0AA, Screen Length From: To: <br /> Consultant: �6UfwFilter Pack From: To: <br /> Geologist: -7p h'VL' Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑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: cotrsaLEti°ty OPN <br /> LEM <br /> Method: Gmund Suxfaca <br /> Screening Method: Orocrt <br /> Verified Chain of Custody: ❑ Yes El No n <br /> it. <br /> it. <br /> SPOILS - — <br /> Contamination Noted: El Yes El No r` _ <br /> If yes,spoils storage Location: •totwd <br /> sacion s' _ <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n• — tt <br /> Grout Material: I " At Ct✓l. <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring InstallationrBoring Destruction Slot Size: <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 /> Il Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Gement 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 <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 (ti 1 \ <br /> Il. J\ 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />