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` SQN.JOQQUIN Environmental Health Department <br /> ° '•'� . _ —COUNTY— <br /> "'i„'�,,::`r Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspect CONSTRUCTION <br /> FacilityAddress: ivi ea <br /> Well Address: Total Depth: <br /> WP# QOl•{ 1 Well#: Drilling Rig Type: <br /> Soil Boring#: _CZ III (01T Min 2"Annular EHD Seal Verified: ❑Yes ONO <br /> Drilling Company: <br /> . GAtA411 <br /> Driller Onsite: AM P44 j Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Di.41oz. Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: f height <br /> SAMPLING ABOVE-GROUND <br /> COMPLETION CHRISTYn <br /> Holding Temperature: coMPleTioNoN <br /> Method: Ground S'"1a°• + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott• <br /> tt. <br /> SPOILS y = <br /> Contamination Noted: El Yes ❑No ° <br /> If yes,spoils storage Location: .wrwd <br /> Covered: ❑ Yes ONO •ec7onPack <br /> c $ <br /> If yes, material: = �� <br /> GROUTING or DESTRUCTION Total Depth: 16, 1 1 lot <br /> Depth to Water: I NO 01W. (A LUtQld t'(f Ttt• — tt• <br /> Grout Material: Nollf U MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: I.At,!saaA <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction d bo-r1rj'Blank Feet Screen Feet <br /> ❑Boring Installation XBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity Wremie ❑Other: Type of Method: <br /> Water men[4716 I Water Cement 941b <br /> allonz I Basis Rallons Baas <br /> Thickest Thinnest ags Thickest Thinnest 4Baga Bentonite/Cement Mix 3% Mix 5%Mix <br /> s 5 1 ✓ s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 10 2 10 20 z Bentonite per 94lb 2.82 4.7 <br /> 7.5 Is 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 s <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 a 40 60 9 <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 />