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= U`N�z SAN.JOAQUIN <br /> Environmental Health Department <br /> —COUNTY <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: i0�2���, Inspector: 9-11,11,:31- tz'`� CONSTRUCTION <br /> Facility Address: <br /> Well Address: A�cr Total Depth: ^' <br /> �7Sk� <br /> WP# 6C, u �1"� Well#: Drilling Rig Type: ucre� <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: El Yes 11 No <br /> Drilling Company: Ccs<<-��z I) �/,� Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: '(ate Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes E]No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: I IFTLheight <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 0016FLflTION cCMPLEnON <br /> Method: Ground Surface T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes L1 No - , ft. <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted = - <br /> eec�on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 1\`/L <br /> Grout Material: NAdk\- cy vw,V <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> g [Boring 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 /> ❑ Gravity EATremie ❑Other: Type of Method: <br /> Water Cement 71 Water Cement 941b <br /> allons Bas izallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest Bags 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 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 35 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 /> r 1,` :M)G��-� W��)� �✓�` �� h^�`S l'^S �Lt I <br /> y_ y <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s*cehd.com <br />