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)�P.VII-CO <br /> $ANJOAQUIN Environmental Health Department <br /> CErtl �1/ —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: / d' Z Inspector: AA e-A— CONSTRUCTION <br /> Facility Address: ZOkr ltu s+ s af <br /> Well Address: Total Depth: <br /> WP# d� 4b37* Well#: Drilling Rig Type: <br /> Soil Boring#: 3B Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: G�ctsZseOQe �}iT�r� <br /> �"Y Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: �1 4�- P ".4 Z� Filter Pack From: To: <br /> Geologist: Ssfk*H Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes,location and distance: � <br /> height. <br /> ram— <br /> SAMPLING ABOVE-GROUND CHRI.,BOX <br /> Holding Temperature: 0OWLErION COMPLEr.ON <br /> Method: caroundsutao. <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No #' <br /> ft. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes []No <br /> ir <br /> If yes,spoils storage Location: .bned i.1W <br /> serlon 4I _ 8 <br /> Covered: ❑ Yes ONO = y,, eta <br /> If yes, material: <br /> �r <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: Nv C+.�J <br /> Grout Material:N eO vy MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �f6 o[O Jd CA-.t Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Q9oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> [M Gravity ❑Tremie ❑Other: Type of Method: <br /> ymfier Ce P25 <br /> er cement 941b <br /> alto ns Bees <br /> Thickest Thinnest uBags Thinnest aBags _ Bentonite/Cement Mix 3% Aix 5%Mix_ <br /> 2.5 5 1 10 1 Bentonite per 47 lb 1 Al 2.47 _ <br /> 5 10 2 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 30 3 -i <br /> 30 20 4 40 4 <br /> 12.5 25 5 50 5 <br /> 15 30 6 60 6 <br /> 17.5 35 7 70 7 <br /> 20 40 40 BO B <br /> 1 o/16/zo17 <br /> 3Z;SN* <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 />