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SAN:-IOAQUIN <br /> —COUNTY— <br /> Environmental Health Department <br /> Greatness grows here. <br /> Monitorin'9 Well/Soil Boring Inspection Report <br /> �1 <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address C O CL, C; . <br /> Well Address: Total Depth: <br /> WP# '-� A 0 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: (�C-L) tiU��r xck icyQ. <br /> Driller Onsite: 51� �,t7J Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: i h�� 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: � 20 V�h � � height <br /> SAMPLING ABOVE-GROUND CHR_ <br /> Holding Temperature: COLPLErlON COMPLETION <br /> Method: GroundStrfaras + <br /> Screening Method: M grout <br /> Verified Chain of Custody: ❑ Yes El No Wd <br /> -�—n' <br /> n. <br /> ft. <br /> —N_ <br /> SPOILS - — <br /> Contamination Noted: ❑ Yes ❑No n` _ <br /> If yes,spoils storage Location: sfanad = __ <br /> sac5on r = <br /> Covered: ❑ Yes ❑No r <br /> If yes, material: <br /> 'graf pa,* <br /> GROUTING or DESTRUCTION Total Depth:2Q- kn�� -_ <br /> Depth to Water: <br /> Grout Material• <br /> ��a� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: %O <br /> 1_j Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity bTremie ❑Other: Type of Method: <br /> Water Cement 471b water cement 941b <br /> allons Bas izallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags 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 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 31-5, 25 5 25 50 5 <br /> 15 30 6 3o 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />