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�z. SAN�JOAQUIN Environmental Health Department <br /> —COUNTY--- <br /> lrI Greatness grows here. <br /> /� Monitoring Well/Soil Boring Inspection Report <br /> Date: "l y 26 Inspector .jG(MrraV CONSTRUCTION <br /> Facility Address: (Q I a . I11d,42�1e L(,P;"/ (0)1) <br /> Well Address: Total Depth: <br /> WP# 260D Well#: S Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: -H(Awn CC <br /> Driller Onsite: Gtlh'LP� Screen Length From: To: <br /> Consultant: ��a.I Filter Pack From: To: <br /> ]�� Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> WT —EW7;F <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWFLETION COMPLETION <br /> Method: G=nd Surface <br /> Screening Method: Oro�n <br /> VZ <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ft. <br /> ft. <br /> SPOILS y: <br /> — - o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: sbttad <br /> ax.on <br /> Covered: ❑ Yes []No = �� <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: = <br /> Depth to Water: <br /> Grout Material: Not <br /> Gallons of Grout Used: I MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout &) Drill Filter Pack Type/Size: <br /> ❑ Gravity remie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bags eallons Bags <br /> Thickest Thinnest )tBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 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 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.slcehd.com <br />