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SAN JOAQUIN Environmental Health Department <br /> --COUNTY— <br /> „ Greatness grows here. li <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 5 2� Inspector: (nG0 CONSTRUCTION <br /> Facility Address: 1 by 1 TOm Dt i1.P. <br /> Well Address: Total Depth: <br /> WP# WeII#: Drilling Rig Type: <br /> Soil Boring#: VJgt C( W' ' <br /> Drilling Company: F�gN1 r Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: 0eQo ti Screen Length From: To: <br /> Consultant: RSA vrAvtt.Zct C-i Filter Pack From: To:PD i <br /> Geologist: 1 )P��a Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: heightIffT <br /> G Iffl— <br /> SAMPLING ABOVE-GROUND CHRIM-Box <br /> Holding Temperature: CO&FLETION Con+aLE CIN <br /> Method: G=ndSuixv <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No ° <br /> If yes,spoils storage Location: �lorod ' <br /> sa i 8 <br /> cdon i = <br /> Covered: ❑Yes ❑No <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth:J�(�t_�jrjt <br /> Depth to Water: 7h f� tt TM <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation XWell Destru� ion Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity 'Kiremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags eall s Bags <br /> Thickest Thinnest 9Bags Thickest Thlnest Bentonite/Cement Mix 3%MI 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite er 471b 1.4 I .4 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.8 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 <br /> 12.5 25 5 35 50 5 y b5 I l y—,trf <br /> 15 30 7 30 70 7 a ,S <br /> 20 35 7 35 70 7 /t �r)lJ"`s/' `-'J 6( <br /> 20 40 8 140 80 8G_/,� <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />