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' SANsJOAQUIN <br /> JJ,�t ,wv.� Environmental Health Department <br /> —COUNTY— <br /> Greatness� rows here.GroA"' 9 ` <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Ct /� Inspector: r�o`- CONSTRUCTION <br /> Facility Address: ��v -�s�K- k- O <br /> Well Address: t-jt+7 G Total Depth: <br /> WP# 0UjQjM Well#: W-Lsht is Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: GYs Ka 1 <br /> Driller Onsite: 3 p Ch�tnGS Screen Length From: To: <br /> Consultant: .ir ., Filter Pack From: To: <br /> Geologist; Sa, w �4 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO using <br /> If yes,location and distance: height <br /> CW7 <br /> SAMPLING Aeove•caot3ND CHRWW-BOX <br /> Holding Temperature: 006FLL71ON COMP1EnoN <br /> Method: Ground Suiacv <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Non' <br /> n. <br /> _n. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes ONO G <br /> If yes,spoils storage Location: alotaa — <br /> ac .on <br /> Covered: ❑Yes ❑No = gravel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: I <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ISVI ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout C9bver Drill� Filter Pack Type/Size: <br /> ❑ Gravity Ml remie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> P25 <br /> ns Bagsallons Bags <br /> Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 5 1 5 to 1entonite per 47 Ib 1.412.47 <br /> 10 2 10Bentonite per 94 Ib 2.82 4.7 <br /> 15 9 1530 3 - <br /> 20 4 20 40 4 15 5 25 (.�+30 6 30 35 7 35 70 7 (�40 B 40 BO B 1 L bJG <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 />