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SAN JOAQUIN Environmental Health Department <br /> '_tet-. ----COUNTY--- <br /> Greatness <br /> COUNTY-- <br /> Greatness grows herr <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 22 Inspector"-Doy I CONSTRUCTION <br /> Facility Address: M°✓e-t 6 - Lh ,� <br /> Well Address:Ilk Z Total Depth: <br /> WP# Well#: ,9wo <br /> e � rilling Rig Type: <br /> Soil Boring#: r <br /> I Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: C.0Y'A� <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: COWPLETION cc#AFiEncN <br /> Method: G=nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No -i--n' <br /> tt. <br /> ft. <br /> SPOILS = <br /> a <br /> _ e <br /> Contamination Noted: ❑ Yes E]No <br /> If yes,spoils storage Location: LA AOr y!� �S Bbtted <br /> LL (' <br /> aK,Fon <br /> Covered: El Yes ❑No V _ <br /> If yes, material: V �,�� � :.�, <br /> GROUTING or DESTRUCTION Total Depth: ~ I y — <br /> Depth to Water:L4 rt/k n- n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation `Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation/❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 11-C-ravity ❑TremieOther: Type of Method: <br /> Water Cement 471b Water Cem t 941b <br /> allons Bas gallons <br /> Thickest Thinnest NBags Thickest Thinnest NBags 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 4 235 <br /> 4 <br /> 1 55 30 65 25 50 50 K C�� �`1�/� �T y I�rJ �•� <br /> 17.5 35 7 70 720 40 8 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.s*cehd.com <br />