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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 11-1'6-Zq Inspector: N As Ek ,. CONSTRUCTION <br /> Facility Address: S31Y m. Delaware tow. <br /> Well Address: Total Depth: <br /> WP#_a c� (2U2z,o Well#: Drilling Rig Type: <br /> Soil <br /> Drilling Company: C n., FI✓� .a Min 2 Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant:_Lo,,lo b Filter Pack From: To: <br /> Geologist: L✓lcC 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 /> —owl: <br /> SAMPLING ABOVE-GROUND <br /> COh1PLETION C -Sox <br /> Holding Temperature: cottrLEOMPLETioN <br /> Method: Grounds"1'0' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott• <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> alottad %! <br /> s an <br /> Covered: ❑ Yes ❑NoQ-1 Pack <br /> _ <br /> If yes,material: e <br /> t <br /> GROUTING or DESTRUCTION Total Depth: LO . = 1 <br /> Depth to Water: 1' <br /> Grout Material:. 0 01,, L—CQ <br /> Gallons of Grout Used: 10 . I f /O 0cl-9 MATERIALS/DEVELOPMENT <br /> ��1 � Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation KBoring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity Mremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement 94lb <br /> allons Bags eallans Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #eggs Bentonite/Cement Mix 3°/a Mix 5a/a Mlx <br /> Is 5 1 5 10 1 Bentonite per 47 lb 1 1 All 12.471 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 i <br /> to 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 BO 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 />