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"�� c°2 SANJOAQUIN <br /> Environmental Health Department <br /> —COUNTY <br /> — <br /> 9�a� �� Greatness grows here. <br /> � <br /> Monitoring Well/Soil Boring Inspection Report <br /> j <br /> Date: 1 13 �`0Zv Inspector: LTJ CONSTRUCTION <br /> Facility Address: k2 ;k C o t <br /> Well Address: '`� Total Depth: j i <br /> WP# ij�0 Well#: Drilling Rig Type: ,r//`� <br /> ,4 ? <br /> Soil Boring#: b' L Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: MCjp �— 1vJi n y�,'vi�. <br /> I _ Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: it , '� Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El 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: OO�''Q�ION CCMPLET1oN <br /> Method: Ground Su lw* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —`---'n' <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: Sion d <br /> sacdon <br /> Covered: ❑ Yes ❑No = 9,VI l <br /> If yes, material: <br /> ;, <br /> GROUTING or DESTRUCTION ITotal Depth: 4. <br /> Depth to Water: <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation XBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons eallons Bags <br /> Thickest Thinnest sBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% 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 so 5 <br /> 15 30 r 6 30 60 6 <br /> 17.5 35 35 70 7 <br /> 20 40 8 40 80 8 <br /> 3 � ILf 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />