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o7° SAN.JOAQUIN <br /> '� Environmental Health Department <br /> ----COUNTY-- <br /> Greatness <br /> ---COUNTY—Greatness grows firm <br /> Monitoring Well/Soil Boring Inspection Report <br /> r� i <br /> Date: JI Inspector: CONSTRUCTION <br /> Ad <br /> Facility dress: 622y50 b P <br /> Well Address: Total Depth: <br /> WP# 3 Well#: Drilling Rig Type: <br /> Soil Boring#: 91 BS Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: "a,26W <br /> Driller Onsite: �,M,,(1A/ Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: VVIA Bentonite From: To: <br /> Ij Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING AeovE-GROUND <br /> Holding Temperature: 0OWLET10N ccOMPLEncN <br /> Method: Ground S`d=* <br /> Screening Method: PA 9f out <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> Q tt. <br /> SPOILS v <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> Li 10-Ft slotted <br /> soclon <br /> Covered: ❑ Yes ❑No 11 , 5- t _ 9-01 Pack <br /> If yes, material: kb -�-t <br /> GROUTING or DESTRUCTION To Depth: 1 ' $ fL = <br /> IF <br /> Depth to Water: b �6 rit $' 35 1 1 % n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size: <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 VTremie ❑Other: Type of Method: <br /> Water merit 411b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest NBags Bentonite/Cement Mix 3% Mix 3% 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 /> 1. 20 4 20 40 4 IJV <br /> 12.5 25 5 25 50 5 II <br /> 7. 30 7 30 70 7 <br /> 10 35 7 35 70 7 ao(-,\I (� <br /> 20 40 6 40 80 8 U <br /> 30'ghns ?a 160LI 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />