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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> ' _ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I/2!/' 4 Inspector: CONSTRUCTION <br /> Facility Address: Z(it",O PIK-15014 <br /> Well Address: Total Depth: If ` FI <br /> WP# 7A 4-10 67, Well#: Drilling Rig Type: <br /> Soil Boring#: (0tr-[Y?_3 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Pe'l a co✓e <br /> DrillerOnsite: a✓Sc Q Screen Length From: % 5 To: <br /> Consultant: 9r.4 Filter Pack From: 45 To: 33 <br /> Geologist: A1a,4 Qum Bentonite From: To: Z9 <br /> Grout From: 74 To: O <br /> ?ra gl+warl <br /> Public Water System Onsite: ❑ ❑Yes No f'nswL 33 3 1 <br /> COMPLETION ❑ Stove Pipe I�IChristie Box <br /> Domestic Well Onsite: El Yes ❑No casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: coLwtETION COMPLETION <br /> Method: Ground Ssaix� <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft• <br /> H. <br /> eft. <br /> SPOILS N - <br /> 4C <br /> Contamination Noted: ❑ Yes ❑No4 <br /> If yes,spoils storage Location: dottod <br /> socdon <br /> Covered: El Yes []No - g-1Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: &(Oot n• — TM <br /> Grout Material: 14 nA c!w«w� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:emu I Casing Type: P V G <br /> cell Installation ❑Well Destruction Blank 15 t Feet Screen LC/' Feet <br /> Slot Size: . GL G <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: 6 (puts S L <br /> METHOD USED Bags Sand/Gravel: .S a + re Ol501"CA <br /> ❑Pressure Grout Dover Drill Type/Brand of Bentonite: t Gc <br /> Filter Pack Type,Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags eall s Bags <br /> Thickest Thinnest nBags Thickest I Thinnest 4aags Bentonite/Cenlent ll 3% MIX 5O.MIX <br /> 2.5 5 1 5 10 1 1 Bentonite per 47lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 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 8 40 80 6 <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 />