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SANsJOAQUIN <br /> I� Environmental Health Department <br /> —COUNTY— <br /> � Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: t/Z3/Z4 Inspector: A.LegcAgl CONSTRUCTION <br /> Facility Address: 2000 Si'1•wt.-,yvl. Vt <br /> Well Address: Total Depth: <br /> WP#_Z4 tG4 Well#: Drilling Rig Type: <br /> Soil Boring#: (SGI -o I Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: 9rv3QCa✓0' <br /> Driller Onsite: err a Screen Length From: To: <br /> Consultant: 1 Filter Pack From: To: <br /> Geologist: llrA i wil- 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 caal ng <br /> If yes, location and distance: hesyht: <br /> SAMPLING ABOVE-GROUND <br /> col wLETION COMPLETION <br /> Holding Temperature: cornr�rloN <br /> Method: oroond S"1"' <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> Ott. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No =_ <br /> If yes,spoils storage Location: <br /> aactfon <br /> Covered: ❑ Yes ❑No _ g-vw <br /> Pack <br /> If yes,material: <br /> q IF <br /> GROUTING or DESTRUCTION Total Depth: 0 t aDepth to Water: 3 tl. ft. <br /> Grout Material: 1/iilrA (PtPA&yJMATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^"I Og C41 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity 1 Tremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest kBags Thickest Thinnest "Bags BentonitelCement Mix 3% Mix 5"/° Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb IAIII 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 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 01 40 80 B <br /> v6bavS "zI&o 10/16/2017 <br /> 1868 E. Hazelton Avenue] Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />