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c°z SAN JOAQUIN <br /> Environmental Health Department COUNTY-Greatness yrows here. <br /> MonitoringWell/Soil Boring Inspection Report <br /> Date: ( I I� Inspector: k�'l T CONSTRUCTION <br /> Facility Address. q9 T�IC(YI' Y1 bS� Stsil �3 v�pSti'� 12�/ '� � <br /> Well Addrp— otal Depth: <br /> WP#_LAa-5� � � Well#: Drilling Rig Type: <br /> Soil Boring#: e in 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: r a �� � <br /> Driller Onsite: / reen Length From: To: <br /> L161 M e_ <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes E]No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION COMPPLEMN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: <br /> El ❑No <br /> n. <br /> ft. <br /> SPOILS ; <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: .toned <br /> .on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING 9 DESTRUCTION Total Depth:_A_1_� • .= <br /> Depth to Water: fL ft. <br /> Grout Material: NQ ai � .QN1- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> 'Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring 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 allons Bags <br /> Thickest Thinnest tlBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% 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 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 1 ay,fuX �& at"ww �t wCd'r 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 />