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SAN,JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greatness grows here <br /> Monitoring <br /> �Well/Soil Boring Inspection Report <br /> Date: �l �di�0c, Inspector: " L. Ltd�'- CONSTRUCTION <br /> Facility Address: �X ijf:'"1 ?,M t (✓61 N-i" (1-/At of �� uS <br /> Well Address: Total Depth: 1 <br /> WP# a_)t1[C SO Well#: Drilling Rig Type: <br /> Soil Boring#: � <br /> Min 2"Annular EHD Seal Verified: ElYes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant:— �G�Yrvf ,i,'� Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: ��,� <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 ABOVE-GROUND <br /> Holding Temperature: CO�"P�tON c�tFncN <br /> Method: Ground Surface <br /> Screening Method: I groLn <br /> Verified Chain of Custody: ❑ Yes El No —n' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: slotted <br /> section "— <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> N <br /> GROUTING or DESTRUCTION Total Depth: . =_ <br /> Depth to Water: n n' <br /> Grout Material: U�e a6t'-P_0_ <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation T 'Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 4Bags 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 15 315 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 1 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 8 8 <br /> R �jj,0 J ' tt� 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />