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2 SA JOAQUIN <br /> COUNTY <br /> Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: _( l 3 Inspector:, ( fl'Yl W�l CONSTRUCTION <br /> FacilityAddress: 3�2.5 S �.1 UC16� [ e{, t11Ck fi7n <br /> Well Address: Total Depth: <br /> WP# 25�MZ Well#: t!)"—3 Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Compan <br /> Driller Onsite: P, Screen Length From: To: <br /> Consultant: InndU0a FX11r laor YwaL �,0�((�Ionc 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 A&]VE-GAOUNp _ <br /> Holding Temperature: COWLETION c =C)N <br /> Method: Ground Surfac+ <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No �ft• <br /> ft. <br /> ft. <br /> SPOILS = <br /> o <br /> Contamination Noted: ❑ Yes ❑No =" <br /> If yes, spoils storage Location: slotted <br /> sacton "— <br /> Covered: ❑ Yes ❑No = W pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 5� _ <br /> Depth to Water: <br /> Grout Material: I 6 &�4 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: I ��,'1':�'�'�� '� �Iq Casing Type: <br /> ❑Well Installation XNell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation El Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> aa t�❑Pressure Grout Over Drill V �y,�f Type/Brand of Bentonite: <br /> "Q"F- Filter Pack Type/Size: <br /> ❑ Gravity N)�Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bags gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest i7Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 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 /> 17.5 35 7 35 70 7 1 20 40 8 40 80 8 l I a Ca LiOv' - Cl/�/24� 15' D- �'^r �9 <br /> �i0/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />