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SANJOAQUIP <br /> Environm al Health Department <br /> —COUNTY <br /> Greatness grows 'fere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:( � Inspector: 10K �� CONSTRUCTION - <br /> Facility Address: 1(,-771 '7 t4*-j L--ct <br /> Well Address: Total Depth: <br /> WP# 00 3&SZ 7 We I#: Drilling Rig Type: <br /> Soil Boring#: F, 7 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company:fir,' pn 6 =!- Screen Length From: To: <br /> Driller Onsite: a rL"e% <br /> Consultant: 4by C. -S Filter Pack From: To: <br /> Geologist: �-wb,�,w Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROMD ' <br /> co <br /> Holding Temperature: COMF'LEMN comPtEnooN <br /> Method: G=nds"ri"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No fL <br /> ft. <br /> ft. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: slotted <br /> = B <br /> sacIon =" — <br /> Covered: ❑ Yes 11 No w <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:2 S <br /> Depth to Water: <br /> Grout Material: n,04- c.t� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> ER <br /> /ell Destruction Casing Type: <br /> ❑ LR <br /> Well Installation WBlank Feet Screen Feet <br /> El Boring Installation ❑Boring Destruction Slot Size: <br /> 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 L9'fremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas Rallons Bags <br /> Thickest Thinnest "Bags Thickest Thinnest #Bags Bentonite/Gement 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 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 1 <br /> .5 25 5 25 30 50 5 11JeA Pw�' w4 '-,54,4,d W 4,11 re rwwted <br /> 1 30 <br /> 17.5 35 7 35 70 7 5-7 Ac,A-ro y wr)->r. rve-I• N—4-v� <br /> 20 40 8 40 80 8 <br /> Su-�`O�s `t 1 ►b b `i ,,�� o�..,,� w 6,��� 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s*cehd.com <br /> %k_1 Nb " 49 <br /> S+cA ►o�s rF <br /> q1 6 b_S 44W u Y-{ <br />