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SAN=JOQQUIN Environmental Health Department <br /> � ! `) — COUNTY <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7_0Inspector: � � 1 CONSTRUCTION <br /> Facility Address: Zj3A h Lu-\. <br /> Well Address: Total Depth: <br /> WP#IQ?001A I I'}� Well#: Drilling Rig Type: <br /> Soil Boring#: 1a) 1 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Q Screen Length From: To: <br /> Cr-V a Lf� <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist:�(A . <br /> 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION CCOAF.ETION <br /> Method: G=nd Surface <br /> Screening Method: Croat <br /> Verified Chain of Custody: ❑ Yes El No �--n' <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No =` <br /> If yes,spoils storage Location: sbnad = 6 <br /> aaclon <br /> Covered: El Yes ❑No _ g,,,w <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 2S - <br /> Depth to Water: n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Ulo <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> gBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Mravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 4Bags Bentonite/Gement 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 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 3 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 209 464-0138 1 www.s'cehd.com <br />