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$ANJOAQUIN Environmental Health Department <br /> I` COUNTY— <br /> .r J <br /> `,,^�r, nias' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �N2�-Z` nspector: Q� CONSTRUCTION <br /> Facility Address: 1531 to W r-U5o c.1�A-1 <br /> Well Address: �� Total Depth: <br /> WP# `k S Well#: Drilling Rig Type: <br /> Soil Boring#: l — S 6 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: EL Tn)L Driller Onsite: Screen Length From: To: <br /> Consultant: 19 j,/ t P,_a/r/LR-dN i��liter Pack From: To <br /> Geologist: W§tsow Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: height <br /> SAMPLING A1;aV9- F1WN0 ci*i rl BOX <br /> Holding Temperature: CONPLElION ooMptFriON <br /> Method: crnas"t'c' — <br /> Screening Method: oran <br /> Verified Chain of Custody: ❑ Yes ❑Noft• <br /> B. <br /> SPOILS — <br /> e ' <br /> Contamination Noted: ❑Yes ❑No 0 <br /> If yes,spoils storage Location: �wtua s <br /> s�cfion � ^ . 3 <br /> Covered: El Yes ❑No w = . <br /> _pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: � S . B <br /> Depth to Water: ft. — ft. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation 4Boring 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 /> Y� Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement 941b <br /> allons Bags Ralkns Bags <br /> Thickest Thinnest NBags Thickest Thinnest #Bags _Bentonite/Cement MIX 3% Mix 50/. MIX_ <br /> 2.5 5 1 s 10 1 _ Bentonite per 47 lb 1 1.411 2.47_ <br /> s 10 2 10 20 2 Bentonite per 94lb 1 2.821 4.7 <br /> 7.5 15 3 15 3o 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 so 5 <br /> 35 s0 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 1 40 1 so 1 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.sucehd.com <br />