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I <br /> ago s� <br /> I"; �,°°_� SANoJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 23 ZDZO Inspector: `v\ �1 CONSTRUCTION �j <br /> Facility Address: 2 31 2 a �OS� I,i /1 D J / <br /> Well Address: Total Depth: Z,2S G 1 <br /> Wp# (well#: Drilling Rig Type: �i QC�t/ <br /> Soil Boring#: 'J C� (2 �h'� � ` Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: �� Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: —7a u-rT >t SSoC S seruntonite From: To: <br /> Geologist: k�lQ <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No Scc CIDC MPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No JZ CI01 casing <br /> If yes,location and distance: � height WT <br /> . <br /> SAMPLING ABOVE-0ROUND Fi <br /> Holding Temperature: COIAaLEfION CCrnaLETioN <br /> Method: r3rotsnd Ssrlaca• + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Non' <br /> n. <br /> _n. <br /> SPOILS <br /> Y O <br /> Contamination Noted: ❑ Yes ❑No r° <br /> If yes,spoils storage Location: slotted "•t o <br /> sao7on = $ <br /> Covered: ❑ Yes ❑No = graval <br /> If yes, material: pack <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: <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 Aring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> 5 Filter Pack Type/Size: <br /> C rA)'*2TremieQ ❑Other: Type of Method: <br /> ?� s 6 l b <br /> Water Cement 471b Water cement 941b <br /> allons Bags aallons BORS <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 94lb 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 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 1 7 35 70 7 <br /> 20 40 B 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 /> I <br />