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�OP,OUip <br /> �� SAN JOA Environmenuai Health Department <br /> —COUNTY— <br /> oe Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I ( l Inspector' s CONSTRUCTION <br /> Facility Address: Ima <br /> Well Address: Total Depth: <br /> WP# n6 1441Well#: 5 Drilling Rig Type: <br /> Soil Bori Min 2"Annular EHD Seal Veo <br /> Drilling Company: �7/gra,0 <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: j� <br /> Grout From: To: S lvr�— Ccs <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 Asovt=.GRourvo <br /> Holding Temperature: COIvPLET10N CCOAAPPLEToN <br /> Method: Ground Surface <br /> Screening Method: wota <br /> Verified Chain of Custody: ❑ Yes El No �f. <br /> tt. <br /> R. <br /> SPOILS <br /> r = - e <br /> Contamination Noted: ❑ Yes El No a" <br /> If yes, spoils storage Location: slonwd _ 3 <br /> s�c7on <br /> Covered: ❑ Yes El Nogravel P-* <br /> If yes, material: <br /> GROUTING or DESTRUCTION Tot Depth: 4. <br /> Depth to Water: n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> *ell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring 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 /> 51-Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Baits <br /> Thickest ? nest #Ba Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> z.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />