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�OP,QUIM C. <br /> SA N.J OAQ U I N Environmental Health Department <br /> —COUNTY- — <br /> q�kPi Greatness grows here. <br /> MonitoringWell/Soil Boring Inspection Report <br /> Date: 2 fP 0 Inspector: r mt CONSTRUCTION <br /> Facility Address: 2[21 7_r(k—LKM'A L <br /> Well Address: Total Depth: <br /> WP# Db" o 2 Well#: Drilling Rig Type: Gti10�61'Le < <br /> Soil Boring#: <br /> Drilling Compan A Cr Min 2"Annular EHD Seal Verified: El Yes 11 No <br /> Driller Onsite: V Screen Length From: To: <br /> Consultant: 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 11 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 00WLEr°N � r <br /> t.enoX <br /> i <br /> Method: Ground Sudact <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stoned <br /> tac�on <br /> Covered: ❑ Yes ❑No = grs„st Pack <br /> If yes, material: % <br /> GROUTING or DESTRUCTION Total Depth:$ <br /> Depth to Water: —ft. 2 F IF <br /> tt' <br /> Grout Material: Nee LZ�wL*0MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring InstallationgBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ITremie ❑Other: Type of Method: <br /> Water (Cement 47115 water Cement 94 lb <br /> allons k Bags - gallons Ba s <br /> Thickest Thinnest st Thinnest #Bags Bentonite/Cement Mix $% 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 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 T1 40 80 8 <br /> 0CpAw2i 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s*cehd.com <br />