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ppU1N <br /> z z SANJOAQUIN Environmental Health Department <br /> < I'�S�•Z,� —COUNTY— <br /> oAt Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7 1� inspector, tlhrtt CONSTRUCTION <br /> Facility Address: Z 61 CAa, 120 . 5 <br /> Well Address: Total Depth: <br /> WP# 0 b 39 q 12_ . Drilling Rig Type: <br /> Soil Boring#: / _ 1�D Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: { , <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: { Filter Pack From: To: <br /> Geologist: 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 aaeing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND CHRk,,BoX <br /> Holding Temperature: 006FLErl°N COMPLETION <br /> Method: r3rouna s atxv <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ONO <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: 4io ad fi EE �k <br /> cation _ a <br /> Covered: ❑ Yes ONO = gra,;,tpack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 124.5 HP <br /> Depth to Water: <br /> Grout Material: o-a C17�)Atkvllr MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation)(Boring Destruction 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 YTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> M2O <br /> ns Bagsgallons Ba s _ <br /> Thinnest #Bags Thickest Thinnest #Bags Bentanitelcernent mix 3% MIX 5%MIX_ <br /> s 1 s 10 1 Bentonite er 47 lb 1.41 2.47 _ <br /> 10 2 10 20 2 Bentoniteper <br /> 94 lb 2.82 4.7 <br /> 15 3 15 30 3 - <br /> 20 4 20 40 4 <br /> 25 5 25 50 s <br /> 30 6 30 60 6 <br /> 35 7 35 70 7 _ <br /> 40 8 40 80 8 <br /> L1 b LS V1f/ rN 2 .S-3 9 &V4 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 />