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SAN JOAQUIN Environmental Health Department <br /> - -COUNTY— <br /> , Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: ANy7Sd19't` CONSTRUCTION <br /> Facility Address: C /tort/ 62,i11/¢116te <br /> Well Address: ,t ^Total Depth: <br /> WP# 2_yGl'Jb-V Well#: 91CJ Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes [-]No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 6h4f' . Filter Pack From: To: <br /> Geologist: 11aftdc 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: IffT <br /> height <br /> Iff— <br /> SAMPLING ABOVE-GROUND <br /> CONFLIEDON C <br /> Holding Temperature: coMrtOMPL eTioNrioN <br /> Method: Ground S"t°o' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �a. <br /> —e. <br /> ft. <br /> SPOILS _ <br /> Contamination Noted: El Yes []No <br /> If yes,spoils storage Location: abnaa :.' _ <br /> Covered: ElYes ❑No Ncd°n fl 8 <br /> Ei <br /> gravel Pack <br /> If yes, material: Liu <br /> GROUTING or DESTRUCTION Total Depth: //fit`/5Depth to Water: 4C tt• tt• <br /> Grout Material: a CP/tz <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> L*essure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ITremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement 941b <br /> allons Bags Rations Be s <br /> Thickest Thinnest pBags Thickest Thinnest #Bags Bentonite/Cement MIX 3% MIX 5%MIX_ <br /> 2.s s 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 -i <br /> 10 20 4 20 40 4 <br /> Us 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 209 468-3420 1 F 209 464-0138 1 www.smcehd.com <br />