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r;�pa SANJOAQUIN <br />Q• <br />COUNTY <br />Greatness Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: q 3 2 Z Inspector: CONSTRUCTION <br />Facility Address: 85k W • k� kC\,. <br />Well Address: Total Depth: <br />WP# 0 Well#: Drilling Rig Type: <br />Soil Boring 2 t Min 2" Annular EHD Seal Verified: <br />Drilling Company: r, ofd, f6h <br />❑ Yes ❑No <br />Driller Onsite: �p 3'eNltCes Screen Length From: To: <br />Consultant: )4-x19mol the r FA!o 1 n fr1 <br />Filter Pack From: To: <br />Geologist: RZ AkVA 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 <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes El No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: ZN <br />3� rk <br />casing <br />height ' <br />ABOVE -GROUND CHRI.-M-BOX <br />COMPLETION COMPLETION <br />Ground sL;rrx. <br />groLd <br />ft. <br />ft. <br />ft. _ <br />��w 3 <br />— o <br />stottsd = c <br />�S; _— Qra,.ot pacsc <br />Depth to Water: 12 tL ft <br />Grout Material: CYC -A � (VMgj). . <br />Gallons of Grout Used: �YiWS r iaa✓ ',��y�A 1MATERIALS/DEVELOPMENT <br />T --r- �' - Casing Type: <br />❑Well Installation []Well Destruction Blank Feet Screen Feet <br />,�\ate Slot Size: <br />❑Boring Installation�$oring Destruction \ Bags of Cement: <br />METHOD USED \� pr Bags Sand/Gravel: <br />h Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill <br />Filter Pack Type/Size: <br />❑ Gravity Mremie ❑Other: Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Raill ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />::Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 1 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 1, <br />15 <br />30 <br />3 <br />10 <br />20 <br />4V <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />\b Bentonite/Cement Mix 3% Mix 5% Mix <br />t4 Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />i <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />