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SANJOAQUIN <br /> ��c Environmental Health Department <br /> —COUNTY--- <br /> ?i �`' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> 12�W4Date: D ! Inspector: S q- _'k_nP.�t CONSTRUCTION <br /> Facility Address: 7-q M Ij lyvm/rA, <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: GP 1 <br /> Soil Boring#: �T „ <br /> Drilling Company: ('1{d (L Fe/til.- Min 2 Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: ►�a, ) 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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION CCOOMPPLEMN <br /> Method: GmiridSurfaes T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> n. <br /> ft. <br /> SPOILS 41 <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: - <br /> sac-ion — <br /> Covered: ❑ Yes ❑No 3` _ g-vlw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: JPO <br /> Depth to Water: O/ <br /> Grout Material: KI4—A+ ow <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation Nhoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity �?Tremie ❑Other: Type of Method: <br /> Water Ib Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest "Bags 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 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 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 />