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SA N 10AQ U I N Environmental Health Department <br /> COUNTY <br /> Greatness grows her_ <br /> ��)� Monitoring Well/Soil Boring Inspection Report <br /> Date: _ ii j G� Inspector: C�'l l�l�i CONSTRUCTION <br /> Facility Address: 311)5 S, ek Dor-qjV v J 1'. <br /> Well Address: Total Depth: <br /> WP# 2 Z';1)10A 7_ WeIW Drilling Rig Type: <br /> Soil Boring#: r _ —) L/ Min 2" Annular EHD Seal Verified: ElYes ONO <br /> Drilling Company:_ 1a EX . <br /> Driller Onsite: J O— s; 5-u1 t 0 C Screen Length From: To: <br /> Consultant: I.nlnt�a i�,�z E�'lVu(MW� ��✓1S. Filter Pack From: To: <br /> Geologist: Ji)V,e <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: WT <br /> height <br /> SAMPLING ABOVE-GRAD <br /> Holding Temperature: C°&F=;CN CCOMPt�TI$CN <br /> Method: G=r)d Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: N Yes El No <br /> EE o <br /> If yes, spoils storage Location: sfottad <br /> on <br /> Covered: ❑ Yes ONO = t4Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: e(')� C_eVW\,0_Vj — MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: I US Uc.I, Casing Type: <br /> ❑Well Installation XLWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 47 Water Cement 941b <br /> allons Ba sgall Bags <br /> Thickest Thinnest 1JBa Thickest Thinnest ilBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 <br /> 5 10 21 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 31 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 /> 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 />