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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness <br /> COUNTYGreatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:C7 1 Inspector:(3///�' , / CONSTRUCTION <br /> Facility Address: 31.222 S• <br /> Well Address: Total Depth: <br /> WP# COD 3 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> rL,t.Gb � T., L Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: C&C& <br /> Screen Length From: To: <br /> Driller Onsite: g <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: 0016F�TION Cotit�noisl <br /> Method: Ground S"t"' <br /> Screening Method: gra,t <br /> Verified Chain of Custody: ❑ Yes ❑No �--tt• <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: atoned <br /> aeon ' = B <br /> Covered: ❑ Yes El No =' <br /> 9-91 Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 20 dR <br /> Depth to Water: 1 ft. tt• <br /> Grout Material: o ` „ $o ;c1r JI <br /> I w <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> MWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity �gTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izallons Bags <br /> Thickest Thinnest pBags Thickest Thinnest pBags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 10 2 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.. 155 15 3 15 30 3 <br /> 12.5 25 s 25 su s CZ"C Co yVtJ�r (5-0 14)�7f wo" <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 �'7 l S to 3 <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 />