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°' c . SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> � q J <br /> +c9trFoa?P% Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 11 021-7i)V Inspector: Gt CONSTRUCTION <br /> Facility Address: S1l �C(xkn St-� C'iWL"Dr\ <br /> Well Address: _ Total Depth: <br /> WP# U9 00_t'I�S�Well#: Drilling Rig Type: <br /> Soil Boring#: ' - <br /> Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: y . <br /> Driller Onsite: �Cuw`e., <br /> Screen Length From: To: <br /> Consultant: Vlakk LZ j LAS Filter Pack From: To: <br /> Geologist: ��,� <br /> Bentonite From: To: <br /> 1 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 /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETX:)N COMPLEMN <br /> Method: Ground Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: aloneo <br /> sacdon � — <br /> Covered: ❑ Yes ❑No <br /> gra-1 pact. <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: NC <br /> Grout Material: N <br /> Gallons of Grout Used:_ MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction � \ Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation 16Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> �J Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: ` Type of Method: <br /> Water Cement 47lb Water Cement 94 lb (� <br /> allons Bags gallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest tJBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 v 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 v 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 V, 15 30 3 <br /> 10 20 4 rr 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 209464-0138 1 www.s*cehd.com <br />