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'C POLIN..^ <br /> z SAN JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:2/21 /Q Inspector: 1)0'r1'0_ gfl,�A /kONSTRUCTION <br /> Facility Address: (,o Ltj (rtl Q <br /> Well Address: Total Depth: <br /> W P# DD 2 Well#: Drilling Rig Type: <br /> Soil Boring#: 63 <br /> Drilling CompanX: r, ( Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: 1' 1� Screen Length From: To: <br /> Consultant: ✓ Filter Pack From: To: <br /> Geologist: P-rL�SSD 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: COMPLETION CC _oMPLEnoN <br /> Method: Ground SLOaes <br /> Screening Method: or«d <br /> Verified Chain of Custody: ❑ Yes El No ---n' <br /> H. <br /> SPOILS <br /> r = - e <br /> Contamination Noted: ❑ Yes ❑No a° <br /> If yes, spoils storage Location: atoll <br /> t�c3on v' — B <br /> Covered: ❑ Yes ❑No = I <br /> ack <br /> If yes, material: (� <br /> GROUTING or DESTRUCTION Total Depth: _/ <br /> Depth to Water: aAa'l— M n' <br /> Grout Material: <br /> Gallons of Grout Used: g Q q o-1orf MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED 114 O' v Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> l Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471 Water Cement 941b <br /> allons Bas inzall ons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest ttBags 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 <br /> 64S. 10/16/2017 <br /> U 5 b ao <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />