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SANJOAQUIN Environmetual Health Department <br /> � I . <br /> A. ��� —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /2'1t*-111 Inspector: (}1S FEw CONSTRUCTION <br /> Facility Address: Z-35-77 S• <br /> Well Address: Total Depth: i <br /> Wptt ooyn34o Well#: Drilling Rig Type: <br /> Soil Boring#: Q/ Go 81I Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: fefd, cco - Screen Length From: To: <br /> Driller Onsite:_rd)Ae { Filter Pack From: To: <br /> Consultant: Z' Bentonite From: To: <br /> Geologist: 0004e .na4l Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No -y casing <br /> ♦j_- ���"�I� height <br /> If yes,location and distance: <br /> SAMPLING ABOVE-oROUND CHglm eox <br /> CowLEr1oN COMPLETION <br /> ETION <br /> Holding Temperature: <br /> Method: grout <br /> Screening Method: A <br /> fl. <br /> Verified Chain of Custody: ❑ Yes ❑No tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes []No 5,34.3ot <br /> c <br /> If yes,spoils storage Location: 5g1to st3 7 =�1 'man = 8 <br /> 1 rl <br /> Covered: El Yes ❑No 686-,bo wb-r A = gravol pacts <br /> If yes,material 6t39 to sp13=10t <br /> GROUTING or DESTRUCTION Total Depth: o yg/S to SD 36 s01 = tt. <br /> Depth to Water: No <br /> tt. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 5111oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> L+YGravity ❑Tremie ❑Other: <br /> Type of Method: <br /> ater ent 47 Water Cement 941b <br /> 1 s 83 allons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement MIX 3%MIX 50%MIX <br /> 2.5 5 1 5 10 1 lBentonits per471b 1 1.411 2.41 <br /> s 10 2 10 20 2 Bentonite per 941b 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 /> 1s 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 1 40 1 80 1 8 <br /> b 10/16/2017 <br /> If W <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s6cehd.com <br />