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SAN J OA Q U I N Environmental Health Department <br /> —COU NTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: f. Inspector: f G(,YVk1 CONSTRUCTION <br /> Facility ddress: VV, Lc'L-F P)Ci <br /> Well Address: Total Depth:rnrn <br /> WP# 1,03'1JJ`4 Well#: Drilling Rig Type: <br /> Soil Boring#: 13 "J_ Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: -7—albe'e- Dr i 1 1 � Screen Length From: To: <br /> Driller Onsite: }� iGIL <br /> Consultant: Filter Pack From: To: <br /> Geologist: F)CWt j P. / [,.0yt.4y­e'y'c� S (� 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 Asovs•GRCUND <br /> Holding Temperature: COWLETfON CCOMPLEMN <br /> Method: Gsid S`dw* <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No —' <br /> If yes, spoils storage Location: slotted = <br /> a4cicn _ <br /> Covered: ❑ Yes ❑No - g­w <br /> If yes, material: "x <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: it• tt' <br /> Grout Material: �2ct^�'�l.' <br /> Gallons of Grout Used: y o MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation XBoring 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 XTremie ❑Other: Type of Method: <br /> Water Cement 4711 Water Cement 941b <br /> allons Bags allons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest ^"Bags 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 /> 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 />