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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> . <br /> Monitor`ing Well/Soil Boring Inspection Report i1 <br /> G <br /> Date. I 2� Inspector: �C�\ l rs CONSTRUCTION �-=� ,ZI <br /> Facility Address: 1 Z LO aV,UA (l il. <br /> T* OP <br /> Well Addr ss: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> _ MVZ, <br /> Soil Boring#: •�,.� Min 2" Annular EHD Seal Verified: ❑ Yes ❑No C-Ito&i Z� <br /> }- I <br /> Drilling Company: '7)wk '�1) �id�U .n , , t <br /> Driller Onsite: Screen Length From: To: • Il7Y.c�QPf'G►, <br /> Consultant: In i i f"-�kr Ick ar, I ' Filter Pack From: To: w Hwy <br /> � <br /> Geologist: Bentonite From: To: CCU <br /> t 'Grout From: To: <br /> C-�IIt)L%. <br /> Public Water System Onsite: ElYes El No COMPLETION ElStove Pipe ❑Christie BooxTb� + 6 2' <br /> 416 <br /> Domestic Well Onsite: [I Yes ❑ casing <br /> No K� <br /> If yes, location and distance: IF� height C'i _ Li, q <br /> 16f A'A q2 <br /> SAMPLING ABOVE-GROUND C403IS•n..3,OX r I�•l_ �v-J <br /> Holding Temperature: COI�LE'TION COMPLETION CCD <br /> Ground svl (,cr <br /> Method: x. �� <br /> Screening Method: groutjUtLl l <br /> Verified Chain of Custody: El Yes ❑No "'�ft: _ = <br /> n C-�( J&2'4.Zt <br /> SPOILS _ "ro ►1 �•y L <br /> Contamination Noted: [I Yes ❑No = Cv _2 <br /> If yes,spoils storage Location: tto"d _ C1 Lo 2L1 <br /> Baryon <br /> Covered: ❑ Yes ❑No j . ' ;S' <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 6VJ <br /> Depth to Water: tt' ', <br /> Grout Material: '3£CA� C�P,Uy�2(1fi �v <br /> Gallons of Grout Used: •n- L MATERIALS/DEVELOPMENT (;-t� '1 ,3 r�D0�(. <br /> qP Y Casing Type: <br /> ❑Well Installation xKWell Destruction \&VIV5 Blank Feet Screen Feet <br /> Slot Size: Pam, h L <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: I <br /> METHOD USED Bags Sand/Gravel: `5 <br /> Type/Brand of Bentonite: r w <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: -1 2 .2 `Ise <br /> El Gravity KTremie (Other: 10 U�S, <br /> Type of Method: *1" 2 I (oa <br /> Water Cement 471b Water Cement 941b i W z �� �� 1 �� <br /> allons Bags allons Bags <br /> Thickest Thinnest NBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 L 40 1 80 B <br /> 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 />