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• SAN J O A Q U I N Environmental Health Department <br /> —COUNTY— <br /> Greatness <br /> OUNTYGreatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �/Z / Inspector: /UA SES►, CONSTRUCTION <br /> Facility Address: /95a & -'e <br /> T <br /> Well Address: Total Depth: <br /> WP# do 3924,2 Well#: Drilling Rig Type: <br /> Soil Boring#: 8 It <br /> Min 2"Annular EHD Seal Verified: E] Yes El No <br /> Drilling Company: �i�,6tP <br /> Driller Onsite:�4[wt <br /> Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> g �„r <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: CONFLE ION CCOMPLErtoN <br /> Method: Gmund SLOwt <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No i--n' <br /> n. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: '10 So.( abtrad <br /> on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: gravol PackZ <br /> GROUTING or DESTRUCTION Total Depth:_% . _ <br /> Depth to Water: D <br /> n. IF — IFtt. <br /> Grout Material: &�1 4e <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation X]Boring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity R]Tremie ❑Other: Type of Method: <br /> 3e {'•;,}-'. <br /> Water Water Cement 941b <br /> gall sgallons Bags <br /> Thickest Thinnest VBags Thickest Thinnest 4Bags 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 /> 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 <br /> K A0-, Hl.0 3 Wo 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br />