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�u•. - to•. �t <br /> ov, rr:,n dctU` J <br /> X , SANS.IOAQUIN Environmental Health Department <br /> —COUNTY— <br /> \�c�c�a Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: , In_spector: a CONSTRUCTION <br /> FacilityA dre s: 22 � 'tr . <br /> Well Address: 7 q Total Depth: <br /> WP# 6 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: L`\� Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: y\ Or br1' Filter Pack From: To: <br /> Geologist: ChC� <br /> 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: ootvwLE ION c1FnoN <br /> Method: Gmird Surface It <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No �--n' <br /> it. <br /> ft. <br /> SPOILS <br /> >v <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: <br /> stoned z,, = . <br /> sak: on — B <br /> Covered: ❑ Yes ONO = lx­+Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n- n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: O C U <br /> 13 Casing Type: <br /> ❑Well Installation ❑Well Destruction `�A Blank Feet Screen Feet <br /> 10 d�c� <br /> ❑Boring Installation ❑Boring Destruction J Slot Size:Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drillgp�vy� Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> },Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b s! <br /> allons Bas eallons Bas <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3%Mix <br /> 2.5 5 1 f 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 /> 12.525 5 25 50 5 <br /> 1s 30 30 0 <br /> 17.5 35 7 35 70 7 Ob o f V6.1' <br /> I' <br /> F <br /> 20 40 8 40 80 8 <br /> ddd 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />