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AN IOAQUINO Environmes Health Department <br />— <br />COUNTY ----Greatness grcws here. <br />j Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: I &5T CONSTRUCTION <br />Facility Ad res : 6wy hyeju &' , (UDLbieA qsziL <br />Well Address: Total Depth: 31 s <br />WP# v03OZO3 Well#: M -+ Drilling Rig Type: <br />Soil Boring#: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: %eL. !Jn —,I - <br />Driller Onsite: kj" MR4N Screen Length From: To: <br />Consultant: /IV 0.71 Filter Pack From: To: <br />Geologist: AAnL,,, PA -(-F Bentonite From: To: <br />Grout From:_3.) T'b4 � To: 23b, Y <br />Public Water System Onsite: El Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 222. 5 <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity )�x emie ❑Other: <br />Plater <br />allons <br />Cement 47 Ib <br />Bags <br />Nater <br />Rallons <br />Cement 941b <br />Bags <br />Thickest TI <br />• nest <br />9Bags <br />Thickest Thinnest <br />HBags <br />2.5 <br />S <br />1 <br />5 10 <br />1 <br />5 <br />_ <br />10 20 <br />2 <br />7.5 <br />15 I <br />3 <br />15 30 <br />3 <br />10 I <br />20 <br />4 <br />n I 40 <br />4 <br />12.5 1 <br />25 I <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 1 60 <br />6 <br />17.5 <br />35 I <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />° <br />40 80 I <br />3 <br />..s; rl-- <br />izeignt <br />COWLEMON ntSi i soy <br />I <br />—ft.. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: ti® <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />BentonitelCement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952.05 1 T 2.09 468-3420 1 F 209 4.64-0138 1 www.s4cehd.com <br />