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$AN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> ., Gre�tnest g,ows here. <br /> f Monitoring Well/Soil Boring Inspection Report <br /> Date: 1l 1. Inspiltor: (-f"' ONSTRUCTION <br /> Facility Address: u l !&L)Odzll j 5mm S <br /> Well Address: Total Depth: <br /> WP# ttiii,443 Well#: Drilling Rig Type: <br /> Soil Boring#: PLOC, Ati ,p5V rfC`IL�� q <br /> Drilling Company: tr Gb toK- lY/w Vf Z� Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: I. fvGo1\ Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes,location and distance: � height <br /> i <br /> SAMPLING V// ABOVE-GROUND ctwlsn,-Box <br /> Holding Temperature: V COWLETION coreriETloN <br /> Method:_ —oroundSuiac�—r—� <br /> Screening Method: arcut <br /> Verified Chain of Custody: C�'Yes ❑No -�—n• <br /> ft. <br /> SPOILS —_ <br /> Contamination Noted: El Yes �No ,� <br /> If yes,spoils storage Location: fi:' <br /> totted , = . $ <br /> wcdon <br /> Covered: ❑ Yes ❑No = llnv'Wvack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth:�l� 1 <br /> Depth to Water: n• — f �TM <br /> Grout Material: . <br /> Gallons of Grout Used: 4- 3�ga- MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size:Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement941b <br /> allons Bags eallons Bags <br /> Thickest Thinnest 48 Thickest Thinnest 9Bags Bentonite/cement MiX 3%MIX 5%Mix <br /> 2.5 5 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 <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 8 40 80 8 <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 />