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° c SAN , OAQUIN <br /> •.� Environmental Health Department <br /> —COUNTY---- <br /> Greatness <br /> COUNTY--- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: C�I2S� Inspector: (7it�L,`Jfv �c<<�i,2 CONSTRUCTION <br /> Facility Address: <br /> Well Address: I(p'1-7S L iwj l(r.AJt dw, CLQ 1 Total Depth: <br /> WP# p p 4.,) q Well#: Drilling Rig Type: <br /> Soil Boring#: a. Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: AA5e l(iS �FmG <br /> Driller Onsite: _./c <br /> Screen Length From: To: <br /> Consultant: 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 ❑No casing <br /> If yes, location and distance: 17 <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: �^¢'�1ON COMP EtloiV <br /> Method: Ground Surface + <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes L1 No �tt' <br /> n. <br /> ft. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes El No <br /> C <br /> If yes,spoils storage Location: .btted <br /> aeon — B <br /> Covered: ❑ Yes ❑NogravoilpacK <br /> _ <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ^_ 04 <br /> Depth to Water: n• n <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation [5tWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> 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 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix S% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 /> 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 B 40 BO 8 <br /> 10/16/2017 <br /> S <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />