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a�c°2 SANsJOAQUIN <br /> Environmental Health Department <br /> —COUNTY <br /> �avvoaN�P/ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2-1�7.aL7� Inspector: dam"''` CONSTRUCTION <br /> Facility Address: /'sy0l s•/�•� 31 <br /> Well Address: Total Depth: <br /> WP#C2nyz7 43 Well#: Drilling Rig Type: <br /> Soil Boring#: 9$ Z� 3 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: jQ bwedliiseo "e6bL <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Tre L e 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 T casing <br /> If yes, location and distance: height <br /> SAMPLING A80VE-GROUND <br /> Holding Temperature: COAFLE ION c wPLEnoN <br /> Method: Ground Surface <br /> Screening Method: or«l <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No =` <br /> If yes, spoils storage Location: <br /> sac�on r <br /> Covered: ❑ Yes ❑No = a <br /> ack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: LS ,Z3 : <br /> Depth to Water: Ale) mre,lei' n• tc. <br /> Grout Material: -&esf 6044 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> /Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest tJBas Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 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 20 40 4 <br /> 11.5 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 /> 1< 10/16/2017 <br /> 1868 E. Hazelton Aven((ue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />