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SANcJOA UIN <br /> Q Environmental Health Department <br /> � COUNTY— p <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspecti�'Report <br /> Date: 5hbw3 Inspector: CONSTRUCTION <br /> Facility Address: -L-N.A 90 <br /> Well Address: tjl-q Total Depth: <br /> WP# l�C'C u ti�tiWell#: W' Drilling Rig Type: <br /> Soil Boring#: is 0% <br /> Min 2"Annular EHD Seal Verified: Yes ONO <br /> Drilling Company: ft�!! : Clo'01c <br /> Driller Onsite: Screen Length From: T0: -� <br /> Consultant: Filter Pack From: TO: '0 <br /> J Bentonite From: To: <br /> Geologist: 6�`Hi --�— <br /> Grout From:_qQL To: (LLt.,C <br /> Public Water System Onsite: `�V� Yes ❑No COMPLETION ❑ Stove Pipe ]Christie Box <br /> Domestic Well Onsite: ❑ Yes No casing <br /> If yes, location and distance: t1el.ynt . <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: r a6PLErioN COMPLETION <br /> Method: Ground Sufaca" � <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> SPOILS <br /> s = , <br /> Contamination Noted: ❑ Yes []No ie <br /> If yes,spoils storage Location: '= s <br /> abtUd B <br /> Faction <br /> Covered: ❑ Yes ONO _ asvalvack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 1 _ S <br /> Depth to Water: 7 — \ n <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casl6gType: 14 L& <br /> ❑Well Installation ❑Well Destruction Blank S% Feet Screen _Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement B4lb <br /> Ilons Bags eallons Ba s <br /> Thickest Thinnest It Bags Thickest Thinnest #Bags BentoniteXament Mix 3%MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 115 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 i F 209 464-0138 1 www.socehd.com <br />