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$AN.JOAQUIk Environmettial Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7-11—It Inspector: CONSTRUCTION <br /> Facility Address: 2240 ;rod er 4(� <br /> Well Address: Total Depth: <br /> WP# .. y oW Well#: ,Sv -is Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: (�tSC e O��Z<<> Screen Length From: To: <br /> Driller Onsite: <br /> �� �� n , Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist: 5ww Grout From: To: <br /> Public Water System Onsite: ❑Yes ONO COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑Yes END casing <br /> If yes,location and distance: height <br /> _CWT <br /> SAMPLING ABOVE-GROUND CHRLM3OX <br /> t'X)69LFTION COMPLETION <br /> Holding Temperature: <br /> �around s —�------- <br /> Method: ors <br /> Screening Method: <br /> Verified Chain of Custody: <br /> ❑ Yes ❑No �n. <br /> _n. <br /> SPOILS = a . <br /> Contamination Noted: ❑Yes []No 3✓6a �` — <br /> If yes,spoils storage Location: A sgin _ B <br /> .�d 3 �-T ,r3 <br /> Covered: ❑Yes []Nov = gr.�rapadc <br /> If yes,material: B <br /> AS <br /> GROUTING or DESTRUCTION Total Depth: _ n n. <br /> Depth to Water: oV <br /> Grout Material: '4 r lCwu MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Z' -7 Y Casing Type: <br /> N(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 /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill 1/ Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie L90ther: Mc ✓ Type of Method: <br /> Water Cenent471b Water cement 941b <br /> allons ea s allons Ba s _ <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags BentonitefCement MIx 3a/a MIX 5a/a MIX <br /> 2s 5 1 5 10 1 1 Bentonite per 47 lb 11.411 2.47 <br /> 5 10 2 10 20 2 JiBentonite per 94 lb 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 5o 5 <br /> is 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 1 e 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 />