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SAN JOAQUIN Environmental Health Department <br /> --COUNTY— <br /> , i;reatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7'w Inspector: CONSTRUCTION <br /> Facility Address:?, SJrtt,Srxn 0) ',t 1 <br /> Well Address: Total Depth:L— <br /> WPH Well#: Drilling Rig Type: U <br /> Soil Boringf#: Min 2"Annular EHD Seal Verified: Yes ❑No <br /> Drilling Company: CIA Linj ➢ <br /> Driller Onsite: '7 r e Screen Length From: s To: <br /> Consultant: r a 5 Filter Pack From:. To: <br /> Geologist: Bentonite From: To:�� <br /> Grout From:�� To: <br /> Public Water System Onsite: El Yes El No T'�a"�rl/L,c„t S«"d <br /> COMPLETION ❑ Stove Pipe Pkhristie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes,location and distance: R height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: cowpLET1ON COMPLEMON <br /> Method: Ground S"1aci <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott• <br /> n. <br /> �tt.SPOILS <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> serJonj _ 8 <br /> Covered: ❑ Yes ❑No — gravel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ?_ <br /> Depth to Water; /V('Ar <br /> Grout Material: Id ecJ GPw et v1- <br /> Gallons of Grout Used: MATERIALS DEVELOPMENT <br /> �i34 rA 1 Casing Type: y y(, <br /> Jell Installation ❑Well Destruction Blank 15 Feet Screent_Feet <br /> Slot Size: .G 0 <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: , <br /> []Pressure Grout Dover Drill Type/Brand of Bentonite: 4 S <br /> Filter Pack Type/Size: <br /> 1+Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 9416 <br /> allons Bags vallons, Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags BentonIte/Cement Mix 3%Mix 5% MIX <br /> a5 5 1 5 10 1 Bentonite per 47 lb I 1A11 2.47 <br /> 5 10 2 10 20 2 <br /> 7.5 15 3 15 30 3 Bentonite per 941b 1 2.821 4.7 <br /> , <br /> 30 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 B 40 00 B <br /> 7 "S ii-t3evl 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 />