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SAN,PJOAOUIN = Environmental Health Department <br /> so"mac <br /> COUNTY <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: IL'11-11 Inspector: Ws'-6c"_ CONSTRUCTION <br /> Facility Address:3er1• s4- <br /> Well Address: Total Depth: <br /> wP#m,1043 Well#: Drilling Rig Type: <br /> Soil Boring#: GT <br /> p - 10 Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: 60kt-Ze-c— <br /> /LU`l� Screen Length From: To: <br /> Driller Onsite: <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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLN COMPLEnON <br /> EM <br /> Method: L3rvund Sudw* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No -�—n' <br /> tt. <br /> ft. <br /> SPOILS <br /> v _ o <br /> Contamination Noted: ❑ Yes ❑No =" _ <br /> If yes, spoils storage Location: dottod A __ <br /> s+cdon <br /> Covered: ❑ Yes El No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water:—,2,3 <br /> n. <br /> Grout Material: /Ne444ce4y-+''�- <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 5'9 <br /> T Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Enoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity C�Tremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix 3%Mix <br /> 2.5 5 1 s 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 t 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.swcehd.com <br />