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((? SAN?JOAQUIN Environmental Health Department <br /> 1� —COUNTY— <br /> \� � �' Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I2 (}Z Inspector: SAQU5 CONSTRUCTION <br /> Facility Address: 5 V5 lam, M(dil\ 5fi. �f LI UY1 <br /> Well Address: Total Depth: _ <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes [I No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ��, �(A,C �. �I Filter Pack From: To: <br /> Geologist: 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: T height <br /> W- 1 I _CrW_T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION CO&i=oN <br /> Method: Ground Surfaon <br /> Screening Method: 01, grout <br /> Verified Chain of Custody: ❑ Yes El No 1 n' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No =" <br /> If yes, spoils storage Location: abed <br /> sac�on -- <br /> Covered: ❑ Yes ❑No = o-VI+Pack <br /> If yes, material: — <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: V3c, Uja4r - tt• tt. <br /> Grout Material: Oewy* <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction ` kl Blank Feet Screen Feet <br /> ❑ r Boring Installation .Boring Destruction e: <br /> U� Bags Slot Size: <br /> Cement: <br /> METHOD USED 3S`� 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 Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 1t Bags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 V, s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2✓ 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 is 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 1 259 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 1 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />