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µ" � SANsJOAQUIN Environmental Health Department <br /> 1"'ct1 '_1f —COUNTY— p <br /> Gree'tness grows here. <br /> .�2 Monitoring Well/Soil Boring Inspection Report <br /> Date: ins pect$ i CONSTRUCTION <br /> Facility Address: Pt VW-%A <br /> Well Address: j Total Depth: <br /> WP# ()n 50 Well#: Drilling Rig Type: <br /> Soil Boring#: W <br /> Drilling Company: Min 2„Annular EHD Seal Verified: ❑Yes []No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: L Filter Pack Frorn: To: <br /> Geologist: Qf1AX1 Bentonite From: To: <br /> �l Grout From: To: <br /> Public Water System Onsite: ❑Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes []No easing ' <br /> If yes,location and distance: height <br /> SAMPLING AeoV,4'�n0MIo cHglsTvbox <br /> Holding Temperature: noMPLETioH <br /> Method: C•mfr d Swoop'�^ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑Noit• <br /> .rft. ft. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No V — o <br /> If yes,spoils storage Location: ab tads <br /> Covered: ❑Yes D oNoN won <br /> Brava pacst <br /> If yes,material:GROUTING-or-DESTRUCTION.Total Depth:---W.... <br /> Depth to Water: ft <br /> Grout Material: m-lefi MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation dell 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 ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity JxTremie ❑Other: Type of Method: <br /> Water Ce nt 471 Water Cement 94lb <br /> R031111 WHOM Bags <br /> Thickest Thinnest p8 Thickest Thinnest #Bags BenteniteXement Mix 3%MIX 5%MIX <br /> 2.5 5 1 5 to 1 Bentonite er471b 1,41 2.47 <br /> s is 2 10 20 Bentonite per 94 Ib 2.821 4.7 <br /> 7,5 15 8 15 00 3 , <br /> IB 20 4 20 40 4 <br /> 12,5 25 5 25 50 5 <br /> 15 so 6 3o so 6 <br /> 17.5 35 7 1 <br /> 35 70 7 <br /> 20 40 9 40 00 0 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952061 T 209 468-3420 J F 209 464-0138 1 www.stoohd.com <br />