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U'"�� SAN��IOAQUIN <br /> 33c� <br /> —COUNTY--- <br /> Environmental Health Department <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: $ �I2oZO <br /> Ins tor: Suy*r`t CONSTRUCTION <br /> Fa ci I ity Ad d ress: 7 Lovie'a 5�-ol <br /> Well Address: Total Depth: /� <br /> WP# 00 (!J Well#: Drilling Rig Type: C ID <br /> T <br /> Soil Boring#: QP T I Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: 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: height <br /> SAMPLING —aw, <br /> A80VE-GROUND <br /> Holding Temperature: CONFLfiMN CCUPtEnON <br /> Method: Gmn°s"t"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt• <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: slotted <br /> Bacton <br /> Covered: ❑ Yes ❑No <br /> vavw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 4. =_ <br /> Depth to Water: n• j — n' <br /> Grout Material: P to MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation �Boring Destruction Slot Size: <br /> 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 Iqfremie ❑Other: Type of Method: <br /> Water Cement Ib Water Cement 94 lb <br /> allons izallons Bags <br /> Thickest Thin t #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 s 1 ►) s 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 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 />