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SAN ,JOAQUIN <br /> Environmental Health Department <br /> 4 J <br /> —COUNTY -- <br /> Greatness grows here. <br /> 11 <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: l bb I4 )Z020 Inspector: �OuLt CONSTRUCTION <br /> Facility Address! `L <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: — 2 Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: 0 Screen Length From: To: <br /> Consultant: TQ41-6–Loo Filter Pack From: To: <br /> Geologist: 61lL `1,_3('ftr*lf d; 4,I�y1/� '�J()�'��i1 Bentonite From: To: <br /> 1�`� ""J► 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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION CC#AP noN <br /> Method: Ground Sulacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> tt. <br /> ft. <br /> SPOILS w <br /> Contamination Noted: ❑ Yes El No =" — <br /> If yes, spoils storage Location: alottaa <br /> aaron -- B <br /> Covered: ❑ Yes El No = g-vlw> <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ <br /> Depth to Water: ,,CA-ey. —ft. '1 <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 Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Ov r Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ,Gravity ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas leall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 'V Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 e 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2-- 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> L 7.5 15 3 0 15 30 3 <br /> 10 20 4 e 20 40 4 <br /> J 12.5 25 5 25 50 5G <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 F 209 464-0138 1 www.s*cehd.com <br />