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SAN„IOAQUIN <br /> Environmental Health Department <br /> 4•'. COUNTY <br /> "=is,jr,:s` / Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3h5l2q Inspector: chi, 4 S CONSTRUCTION <br /> Facility Address: �(�f3� ��,14n1oa1 /��• <br /> Well Address: 7�--T 1 Total Depth: <br /> wPn U4 Li3 lly I p�f Drilling Rig Type: <br /> Soil BoringN: V 3 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: GI CeA d <br /> Driller Onsite: " Q Screen Length From: To: <br /> Consultant: r'fL (AIS 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 El No casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> C0WLETION COMPL TION <br /> Holding Temperature: cot.4alFrioN <br /> Method: Ground sufac0 — <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �„• <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No " <br /> If yes,spoils storage Location: ' <br /> slotted = 'a <br /> aec7on <br /> Covered: El Yes ❑No _ gravol Pack <br /> If yes, material: c -„ <br /> GROUTING or DESTRUCTION Total Depth: 5a14 . 151 5815 :101 <br /> Depth to Water: ��V$��f b, '—t•• n <br /> Grout Material: ;ed: J�j Q y a <br /> Gallons of Grout Used: ti MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation XWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> 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 /> O-Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ment 471b Water Cement 94lb <br /> stations I Ba s eallons Basis <br /> Thickest Thinnest kB Thickest Thinnest #Bags Bentonite/Cement Mix 3%MIX 5% Mix <br /> 2.5 5 11,_ 5 10 1 Bentonite 1er471b 1.41 2.47 <br /> 5 10 2 ✓ 10 20 2 Bentonite per 94 lb 2.62 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 /> is 30 6 30 60 6 <br /> 17.5 35 17 35 70 7 <br /> 20 40 3 40 30 3 <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 />