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aourrr�.. <br /> ! -�c SAN. J0A0UIN Environmental Health Department <br /> I\ `) —COUNTY— <br /> �O4L, P' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I( �3I r 11 Inspector: /dA5E&'wl CONSTRUCTION <br /> Facility Address: ZScY' t►ct,v4 DIQ <br /> Well Address: Cz'D 3WcI,f l Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: :_ l' <br /> Drilling Company: Min 2„ Annular EHD Seal Verified: EJ Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: FYA---e-_ Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes RjNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes Lilo casing <br /> If yes, location and distance: W— T <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLETION cAo&un—=noN <br /> Method: around Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —` n• <br /> tt. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No — <br /> C <br /> If yes, spoils storage Location: atonad <br /> soon — B <br /> Covered: ❑ Yes ❑No <br /> g-vw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: . =_ <br /> Depth to Water: -,4�t fL tt <br /> Grout Material: f1rej f ( rvvV�L+ <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Sorin Installation Slot Size: <br /> gBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> I�ressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite' er 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 1 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazeiton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sucehd.com <br />