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SAN JOAQUIN <br /> '�" Environmental Health Department <br /> .`'�r,r�S' hlZJfri8S5 grows riere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: > S�� 6,/ Inspec or: �t CONSTRUCTION <br /> Facility Address: `7 `7 n t <br /> Well Address: Total Depth:— 6 I <br /> WP# -' 4-4 <br /> W II#: _ Drilling Rig Type: yc•�i� ��E�"L� <br /> t L% <br /> Soil Boring#: — 8`7 <br /> Drilling Company: <br /> Min 2"Annular EHD Seal Verified: L1 Yes []NoL' <br /> Driller Onsite: Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: -— <br /> Geologist: C C) <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROl1ND <br /> Holding Temperature: 00kPLETON c oN <br /> Method: Groundswface — <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes El No �ft- <br /> tt. <br /> ft. <br /> SPOILS :� <br /> Contamination Noted: ❑ Yes El No = •" <br /> If yes,spoils storage Location: abed <br /> s�c'on i = B <br /> Covered: ❑ Yes ❑No _ <br /> If yes, material: s <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: /V ft. — ft• <br /> Grout Material: AId44-t <br /> y��(� <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 Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> �r vitt' ❑Tremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> allons Bas Rall ons Bags <br /> Thickest Thinnest aBags 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 1 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 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 209 464-0138 1 www.s6cehd.com <br />