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SAN JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 01. Le, CONSTRUCTION <br /> Facility Address: 2.orlo 5ha ,tk,,7 YlcJ <br /> Well Address: Total Depth: <br /> WP# 1.40bP t&4 Well#: Drilling Rig Type: <br /> Soil Boring#: GW-04 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: e'A c C.e✓e <br /> Driller Onsite: Qyvcte Screen Length From: To: <br /> Consultant: Qk✓sev's Filter Pack From: To: <br /> Geologist: 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 r casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> CowLErION COMPLE-BOX <br /> Holding Temperature: cornaiErioN <br /> Method: G=rA surlaca <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> n. <br /> SPOILS yy <br /> 9K= e <br /> Contamination Noted: ❑ Yes ❑No ° <br /> If yes,spoils storage Location: ' <br /> tbttad 1 — <br /> txd°n r Covered: ❑ Yes ❑No = 8 <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: S4 I <br /> Depth to Water: N l n•Grout Material: t/tCat te•crtrtr� <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation lBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity Parr emie ❑Other: Type of Method: <br /> Water Cement471b Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MiX 5%MIX - <br /> 2.s s 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 is 30 3 , b <br /> 12.5 25 5 25 50 1, <br /> s 'At LV" kite IVGN ✓N -/ -Lt� n <br /> is 30 6 30 60 6 L✓2 GN` yr,t i n(gv�Cs �• r N{{/ <br /> 17.5 35 `7 35 70 7 r <br /> 20 40 3 40 eo a Stipp edt t.M �(Deh KIAdl y <br /> q t,,,,f,S �C+& J 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 />