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SAN�J0A0UJN Environmei.COUNTY <br /> �1 Health Department <br /> Grentness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: Q�v <br /> Well Address: Sohn -k Total Depth: <br /> WP# Well#: 0 A Drilling Rig Type: <br /> Soil Boring#: (L- \��1 0.- 1-v0 k5&c � Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: kNyStS o�K���a ea�1A`" ,pt.Eo L <br /> Driller Onsite: oI4r Screen Length From: To: <br /> SLy v LFC Sbl � <br /> Filter Pack <br /> Consultant: From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: O.Yes ❑No COMPLETION ❑ stove Pipe ❑Christie Box <br /> Domestic Well Onsite: i kYes []No casing <br /> If yes,location and distance:.A \AO' Iff <br /> height: <br /> SAMPLING�N)V' Aeove.a;nouhlo CHRM,-BOX <br /> Holding Temperature: COWLS ION COMPLETION <br /> Method: Ground Suriacy + <br /> Screening Method: Oran <br /> Verified Chain of Custody: ❑ Yes ❑Noft• <br /> ft. � <br /> SPOILS _ <br /> = e <br /> Contamination Noted:8\Q ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> m:ion +' <br /> Covered: kLYes ❑Nog-vag Pack <br /> If yes,material: S'S`Y1LJ.- 0`lluhN <br /> GROUTING or DESTRUCTION Total Depth:ID V� <br /> Depth to Water: `\' ft. ft• <br /> Grout Material: 13i;.W MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: !'A t\aJ <br /> —� Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction 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 Wremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags Rallons Bags _ <br /> Thickest I Thinnest NB a Thickest Thinnest pBags _BentonftelGement Mix 3% MIX 5%MIX <br /> 2.5 3 a, 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 20 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 r <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 3o 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 1 40 00 0 . <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 />