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' c SANJOAQ UIN Environmental Health Department—COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z� TUN L°'-`'n5pector:� CONSTRUCTION <br /> Facility Address: \ 1,0\ -3 Q�C ( .k ' <br /> Well Address: NM%,-T— Total Depth: <br /> A i <br /> WP# 41 Well#: S •4 ��R" Drilling Rig Type: <br /> Soil Boring#: N Q5 "'AmO0 Drilling Company: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onsite: Ct�� Screen Length From: To: <br /> Consultant: Ltby'V,'V Filter Pack From: To: <br /> Geologist: Z� 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 - I <br /> SAMPLING eBovFGROUND ct�ilsti eox <br /> Holding Temperature: CONPLEr10N t:DMP ON <br /> Method: etwndsutae. ^ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott• <br /> tt. <br /> SPOILS <br /> a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: started c l <br /> section <br /> Covered: ❑Yes ❑No <br /> gmvw pack <br /> If yes,material: = <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: eu, <br /> U Casing Type: <br /> ❑Well Installation PWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation O8arhrg Bestiet} Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Glover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity �Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Ba s Ralicns Basis <br /> Thickest Thinnest HBags Thickest Thinnest "Bags Bentonite/Cement Mix 3%MIx 5%Mix_ <br /> 2.5 5 1 5 to 1 Bentonite per 47lb 1.41 2.47 <br /> 5 to 2 10 20 2 Bentonite per 94lb L 2.821 4.7 <br /> 7.5 is 3 1s 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 7 35 70 7 <br /> 10 40 30 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.s*cehd.com <br />