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SAN JOAQUIN <br /> �< rte• Environmental Health Department <br /> ---COUNTY----- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 21 Inspector: U, CONSTRUCTION <br /> Facility Address: 2S <br /> Well Address: Total Depth: <br /> WP# 00 I 6t 2 Well#: Drilling Rig Type: <br /> Soil Boring#: �P Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: -TA jQ4X <br /> Driller Onsite: D,- I Screen Length From: To: <br /> Consultant: r Filter Pack From: To: <br /> Geologist: C� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COt''F�ION COMPLEnoN <br /> Method: Ground surfeit. —+ <br /> Screening Method: grout S i was <br /> Verified Chain of Custody: El Yes ❑No <br /> 1 C4 S <br /> SPOILS = .: <br /> Contamination Noted: ❑ Yes ❑No T, (r)?T k;kVI-L <br /> If yes,spoils storage Location: slotted = —1U� dSO <br /> Cckitac�on ='• — <br /> Covered: ❑ Yes ❑No = gr,,,*1 Pack 1;4,1 f� t <br /> If yes, material: C�YoU.+Cd ^, 25 F� _ 7 <br /> r' EuLL4 <br /> GROUTING or DESTRUCTION Total Depth: •_>b = C�O��' � <br /> w — <br /> Depth to Water: n- n' ry <br /> Grout Material: �� �l�" B-t MATERIALS/DEVELOPMENT 0 XV <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> []Boring Installation NBoring Destruction <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 Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 'V Bags Thickest Thinnest 9Bags 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 30 0 1 Z <br /> 17.5 35 7 7 35 7 7 7 0 7 VN ` N' <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 />