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SAN JOAQUIN Environmental Health Department <br /> - --COUNTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /l Inspector: lerL. CONSTRUCTION <br /> Facility Address:IMOCI pJ XXAt,"rA syylu,, _eCM <br /> Well Address: Total Depth: <br /> WP#0_()4511(63- Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: d-3/l01'.eg4o1n Min 2"Annular EHD Seal Verified: ElYes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: VII Ei ' Filter Pack From: To: <br /> Geologist: ar/,(^� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: naignb , <br /> SAMPLING ABOVE-GROUND <br /> COIA°LETION COMPLE IO <br /> Holding Temperature: coMaliTloN <br /> Method: Oswnd surface <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes ❑No �tt• <br /> ft. <br /> SPOILS _tt. <br /> Contamination Noted: ❑ Yes ❑No " <br /> If yes,spoils storage Location: % _ <br /> =lotted <br /> secdon <br /> Covered: ❑ Yes []No — gravel pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:W,70 Z <br /> Depth to Water: lot <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 6r, �I Casing Type: <br /> ❑Well Installation TAwell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑B Slot Size:oring 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 f$Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags eallons Sees <br /> Thickest Thinnest pBags Thickest Thinnest k0ags Bentontte/Cement Mix 3% MIX 5% MIX <br /> Is 5 1 5 10 1 Bentonite per47lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite er 941b 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 /> 175 35 7 35 70 7 <br /> 20 40 8 40 80 B <br /> �,I.ja55 u 5er� 10/16/2017 <br /> "9 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />