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SAN.J0A0UIN <br /> ' <br /> COUNTY Environmental Health Department <br /> — <br /> Greatness grows here <br /> r Monitoring Well/Soil Boring Inspection Report <br /> Date: IC ZZ 2DJ� Inspector: 944Y.SC, Gv(: Fe`r�w-L CONSTRUCTION <br /> Facility Address: <br /> Well Address: 1,,9iC '40 qq �,. � (e 5,kCh264 Total Depth: <br /> © <br /> WP# `�U$'�$ Well#: Drilling Rig Type: <br /> Soil Boring#: 9 <br /> DrillingCompany: s' �o ;,l,e�.,,; �4Yd'ty-�nL' Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> p y: e� ,13, Screen Length From: To: <br /> Driller Onsite: Wit <br /> Consultant: Al 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 El No casing <br /> If yes, location and distance: YtT height <br /> 79— —EFW-T <br /> SAMPLING ABOVE-GROUND C__ <br /> Holding Temperature: CONFLETION cotiwtFnON <br /> Method: G=nd Surface <br /> Screening Method: grant <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> ft. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: sb�a <br /> sat�on — <br /> Covered: ❑ Yes ❑No _ 9-01 <br /> Pack <br /> If yes, material: 4' <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n- tt' <br /> Grout Material: rV@. �:-r-_ 4 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation I)gBoring 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 ®Tremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement <br /> allons Bas gallons Bags <br /> Thickest Thinnest 1t Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 0BentonRe per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 <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 1 80 8 <br /> k� xy'k 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />