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`° SAN-JOAQUIN Environmen._7 Health Department <br /> ISM —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> rZ Date: cl JW Inspector: Lep-✓ CONSTRUCTION <br /> Facility Address:_S (or -&A ClA6Lo t <br /> Well Address: {7b1fo lAy),24 "}��yltia Total Depth: <br /> WP# a.3f12I Well#: 1V 'D(e Drilling Rig Type: <br /> Sail Boring#: d7' Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: _ t <br /> Driller Onsite: "- f 0 Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> G �wt t t. t <br /> Bentonite From: ,,To: <br /> Geologist: <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 ABOVEGFDUND ctIflISTY43OX <br /> Holding Temperature: CowLETIDN COMPLETioty <br /> Method: Ground Strlacv 7 <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott' <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: �beNd �:s: <br /> sx7on Si <br /> Covered: ❑ Yes ❑No — g , 1 <br /> Pack <br /> If yes, material: ; <br /> GROUTING or DESTRUCTION Total Depth..T�;+3S_ �- <br /> Depth to Water: L 2. tt. tt' <br /> Grout Material: AeajS Cam, w� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:2 j5n. Casing Type: <br /> ❑Well Installation W<Vell 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 Cv}bver Drill Type/Brand of Bentonite: <br /> � Filter Pack Type/Size: <br /> El Gravity L"JTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 9411a <br /> allons Bags stations Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags _ Bentonite/Cement Mix 3% Mix 5% Mix_ <br /> 2.5 s 1 5 10 1 Bentonile per 47 lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonile per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 i' <br /> 10 20 4 20 4D 4 <br /> 1 25 5 25 50 5 9 7 <br /> 15 30 8 30 0 6 U 1 ((� I <br /> 1Z 7 <br /> 5 35 7 35 0 7 l <br /> 20 40 6 11 40 1 80 8 <br /> 63 -26 1,1 - 67, 61 `tI fL 6� � � � '� 1 6b {,���� � 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, Callii mia 95205 1 T 209 468-3420 1 F 209 4 -0138 1 www.s*cehd.com <br /> '1 `(14b vk" -N(L * q �i1 GS <br />