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SAN JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greatness grows here. <br /> q Monitoring Well/Soil Boring Inspection Report <br /> Date: ( ot� Inspector:Tkla _ 04�k CONSTRUCTION <br /> Facility Address: 7Vor-fh e <br /> Well Address: Total Depth: <br /> WP# © Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: El Yes 11 No <br /> Drilling Compan� I <br /> Driller Onsite: _ r O-o K <br /> Screen Length From: To: <br /> Consultant: (.O vt L rr Filter Pack From: To: <br /> Geologist: /�/(y,r r✓r 5SBentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 1:1 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 0066't.ETION COM LEMN <br /> Method: G=nd Su w* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> ft. <br /> ft. <br /> SPOILS - — <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: atoned <br /> sa�Jon = 3 <br /> Covered: ❑ Yes ❑No <br /> — gravel P_* <br /> If yes, material: <br /> cod- __ . <br /> GROUTING or DESTRUCTION Total Depth: �(2x) <br /> Depth to Water: n- - n' <br /> Grout Material: <br /> Gallons of Grout Used: Jc- �Pj(0/t-S• <br /> MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation NrBoring Destruction Bags iz Cement: <br /> METHOD USED �{X4,rq,-e,,-- _ O N- Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 19 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 s 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 /> 1s 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> a a✓IS �Q _ { 10/16/2017 <br /> 0 (66 2 b�s <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 />