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SAN JOAQUIN Environmental Health Department <br /> t ----COUNTY-- <br /> 9i r�r. Gre°iness 11r1)v,; 11 <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: L / �!k Inspector: CONSTRUCTION <br /> Premise Address: /L777 ."!o•-� � <br /> WP#: taZ9/2 H Total Depth: Z4V <br /> Well#: Drilling Rig Type: - My ✓a <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular Seal Verified: L7 Yes 1:1 No <br /> Driller Onsite: �� , 4,. �.. {�� <br /> Screen Length From: rt-3 To: Z"Iy <br /> C�ws..,.�GL <br /> Filter Pack From: ld'k To: Z-ao <br /> Consultant: <br /> Geologist:_�',,.,r,,,,rW�e.� Bentonite From: fg3 To: t.$T( <br /> Grout From: D To: IS-} <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION L✓1Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: COMPLETION COMPLE710N <br /> Method: G=nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: <br /> El ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> ^+11i <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> sec�on — <br /> Covered: ❑ Yes ❑No = 1 <br /> ack <br /> If yes, material: <br /> >k <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n• F Lj <br /> n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> � � Casing Type: 5�-�-��Lez .S'4Nl <br /> L(/ell Installation ❑Well Destruction Blank Zo 3 Feet Screen_Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: , 0.511t�_ <br /> Bags of Cement: oft <br /> METHOD USED Bags Sand/Gravel: Ot <br /> �„ b..LlserS <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> ��,,°rr�� Filter Pack Type/Size: <br /> 1:1 Gravity L�Jemie ❑Other: Type of Mepthhod: �/ <br /> water Cement 471b Water Cement 941b �U 111 <br /> �� 1�/-Lv <br /> allons Bas lions Bas !„ I� J r <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags ✓' S <br /> 2.5 5 1 5 10 1 BentonitelC men Mix 3% Mix 50% Mix <br /> 5 10 2 10 20 2 Bentonite per 47 Ib 1.41 2.47 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 Bentonite per 94 Ib 2.82 4.7 <br /> 1 25 5 25 50 5 <br /> 15 30 30 0 7 <br /> 17.. 7 7 <br /> 5 35 7 35 70 7 <br /> 20 40 8 40 80 1 8 ��`'I <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 www'sjWCom <br /> I I W, A6 Li"s 1 LtoA-Ao 11 <br />