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SAN JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report 9!10 yat"-+(&4 <br /> I F(� '� 61 Z � <br /> w / <br /> Date: I � � Inspector: u t�� a Y�1 � CONSTRUCTION <br /> Facility Address: ; neer Ayc V✓P� �� A-C <br /> Well Address: Total Depth: <br /> w� <br /> WP# ©� WeelQll#: Drilling Rig Type: <br /> Soil Boring#: Jr U <br /> �i S ,l<<►1 Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: <br /> Driller Onsite: i c Screen Length From: To: <br /> Consultant: SK Filter Pack From: To: <br /> Geologist: Cir I VA nf— <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: 1�tl height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLErlON G�OMtPPLEMN <br /> Method: G=ndSwiac*T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —`---n' <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes 1:1 No <br /> If yes,spoils storage Location: atoned <br /> sacyon = 8 <br /> Covered: ❑ Yes ❑No <br /> �: — gnvst pads <br /> If yes, material: <br /> r � <br /> GROUTING or DESTRUCTION Total Depth:Jift <br /> Depth to Water: no INk+i',f tL n- <br /> Grout Material: ,/&4,+ LCrYK41l <br /> Gallons of Grout Used:©4- S� 3.S4-j,5J= MA ngRTApe/DEVELOPMENT <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> D9 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest Bags 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 /> 6 9°l b� 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 www.s6cehd.com <br />