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SAN4,J0AQUIN Environmental Health Department <br /> — <br /> COUNTY- <br /> -., P' Greatness grows here. <br /> r �1�NMonitoring /W� ell/Soil Boring Inspection Report <br /> Date: lez ! 10 Inspector:'bar-/ 0. /"T • CONSTRUCTION <br /> Facility Address: p-v� S <br /> Well Address: Total Depth: l n <br /> WP# 00 Well#: Drilling Rig Type: 1�] S17 Ll �I <br /> Soil Boring#: - 3 <br /> Drilliing Company: 'ja4 Q,h i .4 n Group Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: J Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: /- P / Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> WT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWFLErj°N CLEMN <br /> Method: Ground Surface <br /> Screening Method: cry <br /> Verified Chain of Custody: ❑ Yes El No -` n' <br /> tt. <br /> ft. <br /> SPOILS <br /> = m <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: slatted _ B <br /> ascdon <br /> Covered: ❑ Yes ❑No gra-4 Pack yes, material: Z��S 1 <br /> C 'x <br /> GROUTING or DESTRUCTION Total Depth: J g3 IF <br /> S : __ .• <br /> Depth to Water n O tt• tt <br /> Grout Material: lye-PI-11 <br /> Gallons of Grout Used: 3 3 Q , MATERIALS/DEVELOPMENT <br /> � <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installationoring 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 /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cemen 9411 <br /> allons Bas pallons Bags <br /> Thickest Thinnest tlBags Thickest Thinnest rt 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 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 /> "-20 n C'I '1 •S h�yQ S 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209`468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />