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SAN. JOAQUIIv • <br /> 2soP,�,co <br /> �- Environmental Health Department <br /> -COU NTY----- <br /> °" iFoaN�P Greatness grows here. <br /> M-1 , <br /> onitoring Well/Soil Boring Inspection Report <br /> Date:I �Aliq Inspecto0,- CONSTRUCTION <br /> Facility Address: C /k St-, <br /> Well Address: Total Depth: <br /> WP00014023f, Well#: Drilling Rig Type: <br /> Soil Boring#: CLI—r—oc <br /> — -Og — <br /> Drilling Company: CO �; ON Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: o Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Q�yt/ Bentonite From: To: <br /> Geologist: _ <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: height <br /> SAMPLING ABOVE-GROUM <br /> Holding Temperature: COMMEE <br /> COMPLETION CCPLnON <br /> Method: °roan°Surfwo <br /> Screening Method: sa�— <br /> Verified Chain of Custody: El Yes El No M <br /> 09 — M <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No ) N � <br /> /�" _ <br /> If yes,spoils storage Location: rt S� �bttad _ S <br /> on <br /> Covered: ❑ Yes 11 No = graw+pack <br /> 47 <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Dgpth: 21 l N '• __ <br /> Depth to Water: oZ'oZ -1' � IF n" <br /> Grout Material: <br /> Gallons of Grout Used: ;ZQA/I o asMATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation Slot Size: <br /> g Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cemen 471 Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest »Bags Bentonite/Cement Mix 3% Mix 3%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 40 80 8 <br /> n O � 5 I,,,,,�C 10/16/2017 <br /> 1808 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />