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(< SAN J OAQ U I N Environmental Health Department <br /> I" * --COUNTY— <br /> �,< P' Greutness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2020 Inspector: vc��Gt ► CONSTRUCTION <br /> Facility Address: / 2�f9 lir {V Ak13-1Well Address: Total Depth: <br /> WP# (0 11( s2 Well#: Drilling Rig Type: 4f, oU�( Ski <br /> Soil Boring#: 91 <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: C7 C—_ W <br /> Filter Pack From: To: <br /> Geologist: &v►lut 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 comPt.EncN <br /> Method: °roind S"rlO" <br /> Screening Method: ar«A <br /> Verified Chain of Custody: ❑ Yes El No �ft- <br /> tt. <br /> ft. <br /> SPOILS y: <br /> Contamination Noted: ❑ Yes El No <br /> C <br /> If yes, spoils storage Location: atoned <br /> Covered: ❑ Yes ❑No <br /> -W Pack <br /> If yes, material: _? <br /> GROUTING or DESTRUCTION Total Depth:�� <br /> Depth to Water: ft• n' <br /> Grout Material: ReA f (2! 11Rm <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags of 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 Cem nt 47 Water Cement 94 lb <br /> allons a s aallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Gement Mix 3% Mix 5% Mix <br /> 2.5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 CZ) 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 r 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 />