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SAKJ0A0UIN <br /> Environmental Health Department <br /> J COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: z5 Inspector: /I/19SfC,-,- CONSTRUCTION <br /> Facility Address: Y34 N41 <br /> Well Address: Total Depth: <br /> WP# n03q If6& Well#: Drilling Rig Type: <br /> Soil Boring#: wAVJ4 Mot? ;i Min 2"Annular EHD Seal Verified: C"lYes El No <br /> Drilling Company: ts�;-. <br /> Driller Onsite: L�.',.r 1 Screen Length From: `IrTo: <br /> Consultant: W"Ai- De-rink Filter Pack From: l3o To: 3o � <br /> Geologist: Bentonite From: L%` To: I <br /> Grout From: n To: 1 <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: W- T <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONPLETION COMPLEnoN <br /> Method: Ground Suiaas <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> tt. <br /> SPOILS <br /> = e <br /> Contamination Noted: ❑ Yes El No =` <br /> If yes, spoils storage Location: stoned _ Z <br /> &*cion <br /> Covered: ❑ Yes El No = g-ve, adc <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: '30 t __ <br /> Depth to Water: z r tt• tt. r <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: Svc. 6�11 yD <br /> NNVell Installation ❑Well Destruction Blank t5' . Feet Screen 15i Feet <br /> Slot Size: t�-61.ta <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: i 1 <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: iA4e PWrZL '�,�" 1,T <br /> Filter Pack Type/Size: 2/Z. <br /> ❑ Gravity ❑Tremie Other: +"ffAtl Type of Method: f►se �r�►l <br /> ater nt 471 Water Cement 941b <br /> all s Bas allons Bags <br /> Thickest Thinnest pBags Thickest Thinnest uBags Bentonite/Cement Mix 3% MIX 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 1 40 8 40 80 8 <br /> r 3.0 g I�L 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />