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SAN, JOAOUI Environmental Health Department <br /> 1 <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z6�q Inspector: W CONSTRUCTION <br /> Facility Address: P1 Ca WW) <br /> Well Address: FN q$-t -ct0 Total Depth: <br /> WP# 3�g 3 Well#: - 1 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: �es El <br /> Drilling Company: <br /> Driller Onsite: <br /> Screen Length From: To: <br /> Filter Pack From: I To: <br /> Consultant: $`� T l <br /> Geologist: Bentonite From: I To: <br /> Grout From: vt� To: 7. <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ;W�Ztove Pipe ❑Christie Box <br /> Domestic Well Onsite: El Yes []No 2-4 rt�PY <br /> casing <br /> heigh <br /> If yes, location and distance: ho>.9nt <br /> _CWT <br /> SAMPLINGABOVE-GROUND c-991STreox <br /> Holding Temperature: cokPLErioN COMPLETION <br /> Method: Ground Svlac1 7 <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: �lotmd <br /> a#c9on <br /> Covered: ❑ Yes ❑No = 9,wel <br /> pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Totiii Depth:__ (� () _ '• <br /> G1d j �4QP�( �5 ft. <br /> 1Vn{ tr• <br /> Depth to Water: � "" <br /> Grout Material: N u <br /> Gallons of Grout Used: ^' MATERIALS/DEVELOPMENT 7 �'1 Lt <br /> Casing Type: �/ 1�� <br /> Well Installation ❑Well Destruction Blank oZ Feet Screen_Feet <br /> Slot Size: 070 <br /> []Boring Installation ❑Boring Destruction <br /> Bags of Cement: ,v <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Nedt <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method:_�YP twt Lt <br /> Water Cement 471b Water Cement941b <br /> allons Bags allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> z.5 s 1 5 10 1 Bentonite er47lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 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.swcehd.com <br />