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fo° N <br /> SANJOAQUIN Environmental Health Department <br /> COUNTY— <br /> \'�qul Greatness grows here <br /> u � Monitoring Well/Soil Boring Inspection Report <br /> Date: IO \ Lo Inspector: \ CONSTRUCTION <br /> Facility Address: Zy�Zvb(*4 Law <br /> \Aie!I Address: _ Total Depth: _ <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: (�'�>= Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: -- ?P_y .mn. <br /> Driller Onsite:, H L W. Screen Length From: To: <br /> Consultant: roa o Filter Pack From: To: <br /> Geologist: STC C_ oachchgr 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: FtT height <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: CO�"P�tON c�t.EMN <br /> Method: Grand Svfacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes 0 N -�—n' <br /> fi. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No ;R <br /> If yes, spoils storage Location: <br /> on <br /> Covered: ❑ Yes El No = Q_VWPack <br /> If yes, material: <br /> 2, <br /> GROUTING or DESTRUCTION Total Depth: ✓0 <br /> Depth to Water: tt• n' <br /> Grout Material: <br /> �-Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: _ <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 7Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> iravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest ltBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 K 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 /> 7.5 15 30 15 30 3 <br /> 10 20 4 ' 20 40 4 <br /> 12.5 25 25 50 5 <br /> 15 30 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 />