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yaUiN co. <br /> SANSJOAQUIN Environmental Health Department <br /> COUNTY----- <br /> ��0��, �/ Greutness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 41 ZU Inspector: CONSTRUCTION <br /> Facility Address: �� (V ;y rl aLut As&-, L6 ��r L`ie (,' <br /> Well Address: Total Depth: ���t C C L�� <br /> W P# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: t'�i6Y1.11n(Ilkm Screen Length From: To: <br /> Driller Onsite: TbYV�u� <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 Aeovt:-Gaourio <br /> Holding Temperature: COMPLETION =APLEnoN <br /> Method: GmneSudece + <br /> Screening Method: oro <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> SPOILS a <br /> >Y = m <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stoned <br /> sacdon r <br /> Covered: ❑ Yes ❑No = g-velpack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 12 c), -_ <br /> Depth to Water: <br /> Grout Material: w'a+ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ! 1Well 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 /> ❑ Gravity I ]Tremie ❑Other: Type of Method: <br /> Water Cement 471b' water Cement 941b <br /> allons Ba allons Baas <br /> Thickest Thinnest XBags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% 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 1 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 /> 5c W�3 iv-dc'- pqf- 6,.ty 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 4608-3420 1 F 209 464-0138 1 www.s*cehd.com <br />