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/ SAN_aJOAQUIN <br /> —COUNTY <br /> Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: k1S ti nc, CONSTRUCTION <br /> Facility Address:IT89 W. YOsem',+,, Ave <br /> Well Address: Total Depth: <br /> WP#00401alt Well#: Drilling Rig Type: <br /> Soil Boring#: itl 42 a 43 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Gulf Shire, Com ictinn vicE' <br /> Driller Onsite: �YOey t- su \e Screen Length From: To: <br /> Consultant: X�(tN b Crnwfcxc{ P, fls«r'icr'tPs.vjc. Filter Pack From: To: <br /> Geologist: PtrnoryAo Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes L1 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> ++ T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COt"��ION �WgXTION <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n <br /> ft. <br /> it. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: atonad <br /> soon = B <br /> Covered: ❑ Yes ❑No c <br /> w 9-vW pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: n5' x3) <br /> Depth to Water:#1 (10'+0 wo 0,VO <br /> Grout Material: iuectt cement- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: e hays (x5) <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring InstallationGrin g Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity F''Tremie El Other: Type of Method: <br /> Water Ce ent 4711 Water Cement 94 lb <br /> allons eall ons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 /> 1�r bv, <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.slcehd.com <br />