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6Urly� <br /> SAN_,JOAQUIN <br /> Environmental Health Department <br /> f —COUNTY— <br /> ��,�,� ,� Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �} 2� Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: _ 60X\Ac kv) kAa)5` Total Depth: <br /> WP# o O` S Well#: Drilling Rig Type: <br /> Soil Boring#: UT-1 <br /> Drilling Company:���Q �Y� C1Qo TQ'S1'j�a iT�C Min 2"Annular EHD Seal Verified: Ll Yes ❑No <br /> Driller Onsite: gQj�- Screen Length From: To: <br /> Consultant: V)Sk �Stat�5� <br /> Filter Pack From: To: <br /> Geologist: M�C�\. <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GRCUNo <br /> Holding Temperature: COMPLETION cor„1PtETIICN <br /> Method: Ground Sumacs <br /> Screening Method: aron <br /> Verified Chain of Custody: ❑ Yes ❑No �fl. <br /> n. <br /> ft. <br /> SPOILS _ <br /> 3 _ a <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: .tcnad <br /> s*c:cn <br /> Covered: ❑ Yes []No <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: _ <br /> Deptn to Water: t 3 � <br /> Grout Material: Hemi eay"e j. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: \OgC\Ik\OVb <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED �� 2 Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity DTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas oallons Bags <br /> Thickest Thinnest "Bags Thickest Thinnest "Bags Bentonite/Cement Mix 3% Mix 55% Mix <br /> 2.5 5 1 --' 5 to i 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 /> 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 35 7 35 70 7 <br /> 2U 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 www.s'cehd.com <br />