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SQN,=JOQQUIN Environmental Health Department <br /> 2 <br /> COUNTY— <br /> `'`9c Foaa`� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 G Inspector: " Vvl(r CONSTRUCTION <br /> Facility Address: 1105 E &L-fMuyj <br /> Well Address: Total Depth: <br /> WP# 0 b;, C1 101-1 Well#: Drilling Rig Type: <br /> Soil Boring#: �10 Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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 ctsrr aox <br /> Holding Temperature: • �1`���N aa> <br /> cc*APLEneN <br /> Method: > Ground satac* <br /> r <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> tt. <br /> SPOILS <br /> yA = o <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted _ 8 <br /> sac�on <br /> Covered: ❑ Yes ❑No g,VW <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Denth: ' <br /> Depth to Water: _ — tt• tt" <br /> Grout Material: ltga�c COxQ,Ix <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> []Boring Installation NDoring 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 /> ❑ Gravity *remie []Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest rlBags 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 <br /> 1 20 4 20 40 4 <br /> . 0 �� —'—dam (l L1I L6 ,V 1 y��`sJLV�L` <br /> 1 25 5 25 50 5 19) 1 <br /> 155 30 6 30 60 6 5 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 1 <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.s'cehd.com <br />