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-` SAN JUAQUIN Environmental Health Department <br /> —COUNTY— <br /> L�F <br /> '�c"�4roaa P' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: N✓ se*" CONSTRUCTION <br /> Facility Address: 76K'Z Pg c.,-k — ,4JG <br /> Well Address: Total Depth: <br /> WP# y(oZ Well#: ZDrillingRigType:IAW=fq/ SV�" <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: El Yes ONO <br /> Drilling Company: s Screen Length From: To: <br /> Driller Onsite: �+���* Filter Pack From: To <br /> Consultant: /¢ i Bentonite From:s L� To: <br /> Geologist: �Ll" Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION El Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: El ONO casing <br /> height <br /> If yes, location and distance: <br /> SAMPLING ABOVE-GROUND C}ipISrY BOX <br /> COMPLETION COMPLETION <br /> Holding Temperature: orwod sun�e. —r-- <br /> Method: grout <br /> Screening Method: tt <br /> Verified Chain of Custody: ❑ Yes ONO n• <br /> ._n. — <br /> SPOILS = a <br /> " <br /> Contamination Noted: ❑ Yes ONO <br /> If yes, spoils storage Location: sactl�lottad <br /> on ; <br /> Covered: ❑Yes ❑No w•",P <br /> If yes, material: <br /> GROUTING or DESTRUCTION T Pal Depth: "40 In, <br /> Q C 1 tt. <br /> Depth to Water: ur v <br /> Grout Material ID MATERIALS/DEVELOPMENT <br /> „ 13 "�� <br /> Gallons of Grout Used Casing Type: <br /> ❑Well Installation 'Well Destructionitwi)�v� t Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED '5vE L:C760 11 Bags Sand/Gravel: <br /> / 7 yp Type/Brand of Bentonite: <br /> ❑Pressure Grout El Drill 8a,� Filter Pack Type/Size: <br /> ❑ Gravity Gd5 remie ❑Other: 9�u✓� tiS+�P Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons 83 s allons Ba s <br /> Thickest Thinnest k Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%",1 ,417 <br /> Bentonite per 47 Ib <br /> 2.5 5 1 5 30 1 . . <br /> 5 10 2 10 20 2 Bentonite per 94 ID <br /> 7.5 15 3 15 3o 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 /> zo 1 40 B 40 3o e 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 'A sicehd Com <br />