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SAW„JOAQUIN Environmental Health Department <br /> -COUNTY— <br /> � TP . Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:toL2_��2_&�nspector: A - CONSTRUCTION <br /> Facility Address: �� W�� ; d e- <br /> Well Address: Total Depth: <br /> WP# l7 Well#: Drilling Rig Type: <br /> Soil Boring#: 1 2- <br /> Drilling <br /> Drilling Company: f a f'CLOV1 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: GTL a Filter Pack From: To: <br /> Geologist: ��UM1A l 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: WT <br /> height <br /> SAMPLING ABOVE-GROUND CHRISTY_ <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Ground Surface <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No �ft• <br /> n. <br /> —ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: slotted <br /> B <br /> on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: ✓l1 <br /> GROUTING or DESTRUCTION Total Depth: lam . <br /> Depth to Water: onL tt• — ft. <br /> Grout Material: <br /> Gallons of Grout Used: �- ' U a V.,II MATERIALS/DEVELOPMENT <br /> 61 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation goring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen471b Water Cement 94 lb <br /> gallons Ba gall ons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest sBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 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 15 3 15 30 3 <br /> 10 20 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 8 40 80 8 <br /> `�✓a( <br /> boas <br /> I _Q s 10/16/2017 <br /> 1868 E. Hazelton Avenue II St kton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sucehd.com <br />