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SA N J OAQ U I N Environmental Health Department <br /> COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: fo Inspector: Cleo,c CONSTRUCTION <br /> Facility Address: tcio(1 V). Qot c4 <br /> Well Address: Total Depth: G� <br /> W P# 2Z G <br /> �;�(, Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: X Yes ❑No <br /> Drilling Company: Ccldplur 111Cr •� ! i <br /> Driller Onsite: 5Cwwt;( 1✓ovt�.r lki-C&at.vc./ Screen Length From: Jai To: $S <br /> Consultant:�� S�"ewS r Filter Pack From: ' To: � <br /> Geologist:_ C"Cwye S Bentonite From: `j k. To: 2 �4 <br /> Grout From: To: 26 r <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe Xhristie Box <br /> Domestic Well Onsite: ❑ Yes ❑No <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION cccMPLEnoN <br /> Method: Ground Surfac. <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt. <br /> SPOILS ft. <br /> = a <br /> Contamination Noted: ❑ Yes El No = <br /> If yes,spoils storage Location: .bid _ <br /> sacrcn = S <br /> Covered: ❑ Yes ❑Nci = Q-vw <br /> Pack <br /> If yes, material: 'x = <br /> GROUTING or DESTRUCTION Total Depth: 2 — <br /> Depth to Water Lf 01 <br /> Grout Material: 1/1,t-04 Cam,t 't s a�6� <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Z C/�j C, <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank ?, , Feet Screen 2,01 Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: C <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: o� <br /> Filter Pack Type/Size: <br /> ❑ Gravity RTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest tlBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 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 /> 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 />