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S A N:J 0AQ U IN Environmental Health Department <br /> " COUNTY — <br /> Greatness grog,- ! <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 25 Inspector:S._rh&qMM VDIliq14 CONSTRUCTION <br /> Facility Address: 10 N. ht � <br /> Well Address: Total Depth: <br /> WP# �E%(f-+ Well#:VA 2- Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Q Min 2" Annular EHD Seal Verified: El Yes []No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: S, 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 casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLErtON clFncN <br /> Method: Ground S"i'`y <br /> Screening Method: grocrt <br /> Verified Chain of Custody: ❑ Yes El No -�--tt" <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: slotted <br /> Covered: ❑ Yes ❑No = g,,,91 <br /> Pack <br /> If yes, material: < <br /> GROUTING or DESTRUCTION Total Depth: -','JI — <br /> Depth to Water: n• n' <br /> Grout Material: At Ceva")-r <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <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 /> ❑Pressure GroutQver Drill Type/Brand of Bentonite: <br /> _ Filter Pack Type/Size: <br /> ❑ Gravity 1 1Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags wallons Bags <br /> Thickest Thinnest 11Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 55% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />