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ntal Health Department <br /> SAN JOAQUII� Environme <br /> —COUNTY— <br /> Greotness grows here. <br /> 1/0 <br /> / <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: -1` '0 Ins ector, w CONSTRUCTION <br /> Facility Address: 14 Z3 B>nurs. <br /> Well Address: Total Depth: <br /> WP# c a 3i ell#: Drilling Rig Type: G� <br /> Soil Boring#: / < 2 11 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: C <br /> Driller Onsite: - , Screen Length From: To: <br /> Consultant: �✓� ��' Q ; Filter Pack From: To: <br /> Geologist: j , Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: T height <br /> SAMPLING A IVE-GRourlo <br /> Holding Temperature: COWLEMN CCXWLnCN <br /> E <br /> Method: Ground Surlxs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft• <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: <br /> stoned <br /> aat.on <br /> Covered: ❑ Yes ❑No _ <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: & M ft. 21ft. <br /> Grout Material: KI 2,* <br /> Gallons of Grout Used: — C� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation $oring Destruction 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 *Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest PBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.s s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 2 15 30 3 20 2 <br /> 15 <br /> 7.5 15 3 15 Bentonite per 94 Ib 2.82 4.7 <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 40 80 8 <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 />