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SAN J 0 AQ U I N Environmental Health Department <br /> --- COUNTY --- <br /> Greotness grows Caere . <br /> Monitoring Well /Soil Boring Inspection Report <br /> II <br /> Date : l0 ;Z ( Inspector : 1 / A CONSTRUCTION <br /> Facility Address : � ff {/e ✓s� 15 • �eij� '�"u �A 41�� <br /> Well Address : r Total Depth : <br /> WP # Lt e2, 3 1 007 Well # : It Drilling Rig Type : <br /> Soil Boring# : 3K r 1 rg 11 PC I N NMin 2 " Annular EHD Seal Verified : ❑ Yes ❑ No <br /> Drilling Company : � i VV <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : � 04- C J S <br /> Filter Pack From : To : <br /> Geologist : nBentonite 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 AWVE-GROUND <br /> Holding Temperature : coiPLEnoN COMPLEMN <br /> Method : G=ndS "rlwo "'+ <br /> Screening Method . grout <br /> Verified Chain of Custody : ❑ Yes El No �-- n' <br /> tt. <br /> n. <br /> SPOILS . <br /> Contamination Noted : ❑ Yes ❑ No <br /> C <br /> If yes , spoils storage Location . <br /> sionad y : — <br /> sac'aon sl — <br /> Covered : ❑ Yes ❑ No <br /> _ flraysl Pack <br /> 1" <br /> If yes , material : = <br /> iKY16GROUTING or DESTRUCTION Total Depth : <br /> Depth to Water : {�c� ` M tt' <br /> Grout Material : MATERIALS/ DEVELOPMENT <br /> Gallons of Grout Used : Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation loring Destruction Slot Size : <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 /> ravity ❑ Tremie [:] others Type of Method . <br /> Water Cemen 471b Water Cement 941b <br /> gallons Ba gall ons Bags <br /> Thickest Thinnest # Bags Thickest Thinnest Bags Bentonite/Cement Mix 3 % Mix 5 % MIX <br /> 2. 5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> s 10 2 10 Zo 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 /> 12. 5 25 5 25 50 5 <br /> 15 30 6. 30 60 6 <br /> 17. 5 35 =7 35 70 7 <br /> 20 40 40 80 8 <br /> 10/ 16/ 2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464- 0138 www . smcehd . com <br />