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SAN IOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: v2(3 /11 Inspect r:Su. CONSTRUCTION <br /> Facility Address: A�A� PIU 1. (AN Z04kU/ Ka <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: k rG12av�. <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 26(,V` Filter Pack From: To: <br /> Geologist: 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: height <br /> SAMPLING A OVE-GROUND <br /> Holding Temperature: COMPLETION cOCMPLEnON <br /> Method: Ground Sudw* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted _ B <br /> 10 <br /> aeon <br /> ❑ ❑ _ <br /> Covered: Yes No Q I _ _ 94,VIW P--k <br /> If yes, material: 2-- to ~` <br /> GROUTING or DESTRUCTION Total Depth: 3j o <br /> Depth to Water: U �5 n. n <br /> IF <br /> Grout Material: 5" ~ <br /> Gallons of Grout Used: (7" l� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 9 Gravity [�Tremie ❑Other: Type of Method: <br /> Water C ment 411# Water Cement 94 lb <br /> allons Basgallons 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 /> s 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 /> 1 25 5 25 50 5 � _ IJ P VC�r ' V"Gl i U'� C: l"` � <br /> 155 30 6 30 1 60 6 J � .p <br /> �.�. <br /> 17.5 35 7 35 70 7 ^n� 1^ / ARCHW(Ait ` <br /> 40 80 <br /> 20 40 8 8 W/ V� <br /> R 6 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 />