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i, SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> F�rP` Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector:STl n) Vdhyr� CONSTRUCTION <br /> Facility Address: WD Ii.{�jehle►2 t �Y� �(/�I u� <br /> Well Address: Total Depth: <br /> WP#?Ev8 qs­-� Well#: HW L-t• Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: L(1°(�1CG' <br /> Driller Onsite: —�U(�1'1 Screen Length From: To: <br /> �lfil <br /> Filter Pack From: To: <br /> Consultant: <br /> Bentonite From: To: <br /> Geologist:1 0kh <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 /> SAMPLING AE&E-GROUND <br /> Holding Temperature: COWFLETION COMPLEncN <br /> Method: Ground Six' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> sac9on <br /> Covered: ❑ Yes ❑No = sas�+a� <br /> If yes, material: x <br /> GROUTING or DESTRUCTION Total Depth: ki Depth to Water: tt —ft. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: I IN 0a l onS <br /> Casing Type: <br /> ❑Well Installation Nell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> gt, S Type/Brand of Bentonite: <br /> El Pressure Grout Over Drill ���� <br /> Filter Pack Type/Size: <br /> ❑ Gravity �jTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags Rallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags 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 Eq <br /> 20 40 4 <br /> 12.5 25 25 50 5 <br /> 15 30 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 />