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SAN JOAQUIN Environmental Health Department <br /> — —COUNTY <br /> Greatness grows here. <br /> nn Monitoring Well/Soil Boring Inspection Report , 1��: <br /> Date: 51101Z Inspector: s M CONSTRUCTION wIl ' 69-1 <br /> Facility Address: 11i6OX J <br /> Well Address: Total Depth: gYOt w FGIouF <br /> WP# Well#: Drilling Rig Type: y (1tQ <br /> Soil Boring#: I Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: R height <br /> SAMPLING ABOVE-GROUND <br /> COMPLETION COMPLETION <br /> Holding Temperature: con3r�ETioN <br /> Method: C4ourd s xlan '+ <br /> Screening Method: grout <br /> Verified Chain of Custody: El Yes ❑No �tt' <br /> tt. <br /> —n. <br /> SPOILS Y <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> sacyon �p = B <br /> Covered: ❑Yes ❑No — <br /> If yes, material: <br /> GROUTING or DESTRU TIONTotal Depth: 30Depth to Water: 1 n. t z Is n. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^- <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation NBoring 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 I9Tremie ❑Other: Type of Method: <br /> Water Cement 4711a Water Cement salt <br /> allons Bags gallons X Bags _ <br /> Thickest Thinnest #Bags Thickest Thinnest #Ba _ Bentonite/Cement Mix 3%MIX 5%MIX <br /> 2.s s 1 5 10 1 Bentonite er 47 Ib 1.41 2.47 <br /> s 10 2 10 20 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 s 25 50 5 <br /> is 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 00 8 <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 />