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SANtJOAQUIN <br /> 1j —couNTY— Environmental Health Department <br /> `n Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:?)NAWN Inspector: CONSTRUCTION <br /> Facility Address: l0304 W.Wow 0 IQ <br /> Well Address: Total Depth: <br /> WP# 0 Well#: Drilling Rig Type: <br /> Soil Bori g#: l r 2.4 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company:&3Vto% 4wrea,61 Cu & AIsa as <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: ;c4 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes,location and distance: height <br /> SAMPLING Aeove-GacuND <br /> CgWLErION CE Box <br /> IO <br /> Holding Temperature: co6nrLOMPLnoNe <br /> Method: G=nd Sulac• <br /> Screening Method: aroul <br /> Verified Chain of Custody: ❑ Yes ❑No #. <br /> H. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No ° = <br /> If yes,spoils storage Location: bttad <br /> =n _ B <br /> Covered: ❑ Yes ❑No _ SIM <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 11 14 <br /> Depth to Water: L41A n• — �n• <br /> Grout Material: in Cewtern <br /> Gallons of Grout Used: 61J.5 ¢ CAI MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation TBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Orill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> fliGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement941b <br /> allons Bags gallons Baas <br /> Thickest Thinnest kBags Thickest Thinnest NBags _ Bentonite/Cement Mix 8%Mix 5% Mlx <br /> 2.5 5 1 5 10 1 1 Bentonite per 47lb I IIA1 2.47 <br /> 5 10 2 10 20 2 lBentonite per 94 lb 1 2.82 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 /> 2 "S µs0"1 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 />