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U "z SANIJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �S 20 Inspector: V�4iecas CONSTRUCTION <br /> Facility4dress: ,ZOO WQlAA0teM!S P000 SfOfkr}A <br /> Well Address: —Q _ Total Depth: <br /> WP# Wkl"to2 Well#: Drilling Rig Type: <br /> Soil Boring#: Z lu Min 2"Annular EHD Seal Verified: ElYes []NoDrilling Company:. C1e0 b1C . SUEU c� �glum+;on <br /> Driller Onsite: 6 5 CarO5 Screen Length From: To: <br /> Consultant: �-)(�A{^Qk em IM <br /> Filter Pack From: To: <br /> Geologist: 5co* 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: IFfLT height <br /> 79-- —1KVT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: a=nd Surface <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> SPOILS = <br /> = o <br /> Contamination Noted: ❑ Yes []No <br /> C <br /> If yes, spoils storage Location: <br /> wocicn — <br /> Covered: ❑ Yes ❑No = 9-VW <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: MIIA, ft• tt. <br /> Grout Material: 10(�t4-be0, -Ai- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 046 <br /> L Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest IBags Thickest Thinnest NBags 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 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 www.s'cehd.com <br />