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S A N J0A <br /> (= l ,_,. . `zi Q U I N Environmental Health Department <br /> _i` � .. � —COUNTY— <br /> c n <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /yy Inspector: l 6 CONSTRUCTION <br /> Facility Address: 'ZGC$o '4rrasrw 1(L/ <br /> Well Address: Total Depth: <br /> WP#vtoo 1 C04 Well#: Drilling Rig Type: <br /> Soil Boring#: (.v-OS 1 GWKil <br /> Drilling Company:—P_C�tSG o Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: c o Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist:klotw &WA Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-0FOUND <br /> COAIPLETx]N CON <br /> Holding Temperature: COMPLETION <br /> Method: Ground sun'°' <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = M <br /> If yes,spoils storage Location: fi <br /> abdad <br /> tectlon1 <br /> Covered: El Yes ❑No <br /> If yes, material: <br /> t t <br /> GROUTING or DESTRUCTION Total Depth: _J(1 = .. <br /> Depth to Water: 46,1 <br /> Grout Material: Ofv& f C&L.40r+ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: —tv 4 I' <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ��,,1111 <br /> ❑Boring Installation Bering Destruction Slot Size:Bags of Cement: <br /> METHOD USED II Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 14"remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest IThinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 15 5 1 5 10 1 Bentonile per 47 lb I t 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 1 <br /> 12.5 25 5 25 50 5 (-1\yr„1 k' a ✓G N G'ti'�l <br /> 15 30 6 30 60 6 ^ V Cµ l ,�P ,S�C�S CT k vl�o <br /> 175 35 7 35 70 7 wt i Y <br /> 20 4B 1 B 40 84 B SNP��raA *C4� 1 Ku-j, 9� 6 <br /> 9 ws 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />