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. SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> `art✓� Greutness grows here. <br /> Monitoring�W�ell/Soil Boring Inspection Report <br /> Date: `II IS)2u Inspector: fTn\ ,Sc 2 CONSTRUCTION <br /> Facility Address: e'41 ,tib' OAI-4 j &- <br /> Well Address: Total Depth: C, <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: — C 0-� Z Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: < z, <br /> Driller Onsite: "C k Screen Length From: To: <br /> Consultant: <br /> Filter Pack From: To: <br /> Adr,�'Q.h <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: �Md —aw, <br /> T height <br /> SAMPLING ABOVE-GROUND CHRM _ <br /> Holding Temperature: COWLEnoN COMP1.EMN <br /> Method: Grwnd Sudwit <br /> Screening Method: groes <br /> Verified Chain of Custody: ❑ Yes El No tt' <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> slotted <br /> &*Cyon <• = B <br /> Covered: ❑ Yes ❑No = ve,v <br /> ack <br /> If yes, material: x <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: , tt• tt' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation PBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity (ATremie ❑Other: Type of Method: <br /> Z'water 7 47lb Water Cement 941b <br /> allons allons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 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 /� e� t <br /> 17.5 35 7 35 70 7 "Q,(�'� — Ot- 1_W"-1 ttj <br /> 20 40 8 40 80 8 / o <br /> t CXd�Gr .,PDX/ <br /> 10/16/2017 <br /> 1868 E. ze�t 1 Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />