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SAN JOAQUIN Environmental Health Department <br /> —COUNTY- <br /> -- Grca,nrss q,ows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: O Inspector: r CONSTRUCTION •, <br /> Premise Address: �1-7'1 r o.Jt.wat. gad — <br /> WP#: 170ft?-y Total Depth: Lqy <br /> Well#: vim► Ike Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular Seal Verified: B?'Yes El No <br /> Drilling Company: opn I. <br /> 1,00a����� Screen Length From: �V To: <br /> Driller Onsite: "'"' Filter Pack From: q5To: l-°(u <br /> Consultant: CTAS 4v✓�c e <br /> Geologist: Co ..,�n e- Bentonite From: To: Pb— <br /> Grout From: To: ICO <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-GROUND <br /> Holding Temperature: GOWPLFTION C-CWL ETION <br /> Method: G=ndSurface T <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> a <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: stood <br /> saclon x — <br /> Covered: ❑ Yes ❑No <br /> g-vW pack <br /> If yes, material: 3 <br /> GROUTING or DESTRUCTION Total Depth: 7 <br /> Depth to Water: n- ft' <br /> Grout Material: ✓)-c. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: S{,,,.,..A,.-_S <br /> PNV'ell Installation ❑Well Destruction Blank L-3 Feet Screen_ Feet <br /> Slot Size: . Qh^5- <br /> []Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: 1-i 1 6oblbf t2 SUIS ) <br /> Type/Brand of Bentonite: ft <br /> ❑Pressure Grout Drill Filter Pack Type/Size: <br /> ❑ Gravity LS-Tremie ❑Other: Type of Method: , <br /> � 4" ' <br /> Water Cement 471b water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest xBags Thickest Thinnest 4Bags <br /> 2.5 5 1 5 10 1 Bentonite/Cement Mix 3% Mix 5% 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 /> 12.5 25 5 25 50 515 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 9 �, 4 l 40 <br /> 20 40 a 40 so 8 / 7 11 <br /> 5 <br /> 1868 E. Hazelton Avenue 1 StoLkton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> it � X171 L. 1.,& f.__, III <br />