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SAKJOAQUIN <br /> Environmental Health Department <br /> =COUNTY— <br /> �Pggstj`/ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date; Inspector: CONSTRUCTION <br /> Facility A dress; t <br /> Well Address: Total Depth: 7` 5 <br /> WP# Well#: AV)1*-(0 Drilling Rig Type:_KUCL►"D <br /> Soil Boring#: l2VJ 11� (IT ASS Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company:_ 1 iW 6�c — <br /> Driller Onsite: Screen Length From: To: <br /> Pa <br /> ck ack From: <br /> Consultant: 6h LAM. L�E To:-• <br /> Geologist Latirft Bentonite From: 14, TO: <br /> Grout From:_ TO: ! <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe Othristie Box <br /> Domestic Well Onsite: ❑Yes []No <br /> casing ' <br /> If yes,location and distance: height <br /> SAMPLING AgpyE Sapp <br /> Holding Temperature: CCIM'LErION cCMI LArTiooN <br /> Method: t -_— <br /> Screening Method: grjat y <br /> Verified Chain of Custody: ❑Yes El No -�-�--ft <br /> ft, <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No o <br /> If yes,spoils storage Location: s <br /> akriad <br /> Covered: ❑Yes ❑No sae9cn <br /> (". T pravatpxit <br /> If yes,material: <br /> GROUTING-or-DESTRUCTION Total Depth: t =.,t. � _. <br /> Depth to Water: it- <br /> Grout Material Noor C4Aw-A <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> ti 6$AAA. Casing Type:_CI ,Y i e} bo)C <br /> ®,Well Installation ❑Well Destruction Blank n- 2(_ Feet 5u-q Screen -zo- Feet <br /> Slot Size: � 04S <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: CmA Cw o Gt1l n5 . xl 3 <br /> ❑ Gravity XTremle ❑Other: Type of Method:�PPG`Xvt1r�6� ,,s +.Q_ <br /> Water Ce nt 471b Weter cement941b <br /> allons RAMS Bags <br /> Thickest I Thinnest Thickest Thinnest Itfiags Bentonite/Cement Mix 3°1° Mix 5% Mix <br /> 2.5 5 If 5 10 1 Bentonite per471b 1.41 2.47 <br /> 5 20 2 10 20 z Sentonlle per 94lb 2.821 4.7 <br /> 75 15 3 15 3o 3 <br /> 10 z0 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 80 60 - 6 J <br /> 17.5 85 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 /t}/ <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com i <br />