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SANJOAQUIN Environmental Health Department <br /> —COUNTY <br /> C; <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �l Z Inspector: i CONSTRUCTION <br /> Facility Address: 1S 0 <br /> Well Address: Total Depth: <br /> WP44 WeII4: Drilling Rig Type: <br /> Soil Boring#: 9-.;,\ Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: T4>irm(C)h <br /> Screen Length From: To: <br /> Driller Onsite: ,nnA, <br /> Consultant: rr to Filter Pack From: To: <br /> Geologist: �C C-��' � � Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes L1 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: COWPLE ION CCO _OMPLEnON <br /> Method: Groune Surface ' + <br /> Screening Method: Iut <br /> gro <br /> Verified Chain of Custody: ElYes El No 4, ft. <br /> ft. <br /> tt. <br /> SPOILS <br /> - a <br /> Contamination Noted: ❑ Yes EJ No — <br /> If yes,spoils storage Location: abtd <br /> aeon - 3 <br /> Covered: ❑ Yes ❑No Y _ g-VW Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 51-1i. _ <br /> Depth to Water: 3kn• <br /> Grout Material: ��(J�,�Vt MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 2 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction 2 �Z�6 � Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation §QBoring Destruction <br /> b�5 Bags of Cement: <br /> METHOD USED �� <br /> �` Bags Sand/Gravel: <br /> � ��� Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity 7Tremie ❑Other: Type of Method: <br /> ,1 Water Cement 471b Water Cement 94110 <br /> allons Bas eallons Bags <br /> Thickest Thinnest ABags Thickest Thinnest #Bags 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 V 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 1 3 <br /> 10 V 20 4 '✓ 20 40 4 <br /> 12.57 25 5 ✓ 25 50 5 <br /> fv 15 V 30 6 V 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 209 464-0138 1 www.sucehd.com <br />