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SA N J OAQ U I N Environmental Health Department <br /> - COUNTY- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z5 Inspector: .Le CONSTRUCTION <br /> Facility Address: (L,riuGVl `�' ti �s SVP 2;17S_ 6 <br /> C1 <br /> Well Address: 2"LGI L✓c o4,�. jFr,, SL Total Depth: �J 4S. s <br /> WP# 2s os 7S Well#: Drilling Rig Type: <br /> Soil Boring#:jjj-R- Ih)_-I�$ -lG(YSv� - l`1 Min 2"Annular EHD Seal Verified: rg Yes ❑No <br /> Drilling Company: ?Coe D✓-1 Nu <br /> Driller Onsite: wl :u u of <br /> Screen Length From: 5 5'6' To: 4111"/515" <br /> Filter Pack From: ' ' 1' To:Ylo`rl`i` <br /> Consultant: 31`tll <br /> Geologist: V✓l ✓GG.y1 Bentonite From: 'lo"/4�yh To: <br /> Grout From: 'V ' To: O`l G' <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing !! <br /> If yes, location and distance: 311 <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLEDON CLEMCNi <br /> Method: Ground surf"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: .tox�d <br /> sacdon — � <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:3 YlU`ZYIS <br /> Depth to Water: 5,5` <br /> Grout Material: !/1 CGt. CewtepK,l- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 16.3 n <br /> Casing Type:01 .ZS" 16 S41re t�Gt,.. ��-tbr� <br /> ❑Well Installation ❑Well Destruction Blank`I'tt" S'S4--gt U Screen t" Fact <br /> []Boring Installation 1�4Boring 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 /> ❑ Gravity SATremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags eallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 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 8 40 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 />