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;<°P "c� SANJOAQUIN <br /> Environmental Health Department <br /> r --COUNTY--- <br /> Greatness grows here. <br /> (J Monitoring Well/Soil Boring Inspection Report <br /> Date: I 'I ewinspector: j'O,, CONSTRUCTION <br /> Facility Address: jvcl c4 X4 <br /> Well Adclss: Total Depth: <br /> WP# L Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes L1 No <br /> Drilling Company: rr i yl <br /> Driller Onsite: f7 Screen Length From: To: <br /> Consultant: L 1, & p(ub 1 F,4oC'a-�fLS. Filter Pack From: To: <br /> Geologist: Ij DW� 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: height <br /> A 0 —aw, <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWFLET1ON COOMPLEnoN <br /> Method: Ground Sumacs <br /> Screening Method: aroul <br /> Verified Chain of Custody: ❑ Yes ❑No �tt• <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No =" <br /> If yes, spoils storage Location: ato�d <br /> Covered: ❑ Yes ❑No D 5-- <br /> S I s�c:cn _ P <br /> If yes, material: -40 <br /> 6� <br /> 1 <br /> GROUTING or DESTRUCTION Total Depth:�D•�'f 17 `2` ;. <br /> Depth to Water: o O IA J <br /> Grout Material: <br /> Gallons of Grout Used: Cl be j MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> �11Slot Size: <br /> ❑Boring Installation oring 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cemen Ib Water Cement 941b <br /> allons Bag gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest aBags 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 10 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 B 40 80 8 <br /> L)S �H is- o� S 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 />