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SAW-JOAQUIN Environmental Health Department <br /> _•I :_ COUNTY <br /> Ov, P Greatness grows hr e. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: i� 2 Inspector_4 , f ly VO CONSTRUCTION <br /> Facility Address: ' 1 <br /> Well Address: —�^ Total Depth: <br /> WP# 21LON k54(n Well#: Drilling Rig Type: <br /> Soil Boring#: r �6 Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: bc,49 hG <br /> Driller Onsite: IScreen Length From: To: <br /> Consultant: I� M Y11(1121�n{O'LQr1 >�QS�h 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: height <br /> SAMPLING Mi;VE-GROUND <br /> Holding Temperature: COA'F=10N ccomPLEnON <br /> Method: G=ndSudacs T <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes El No �n. <br /> ft. <br /> it. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: •tottQd <br /> soc+on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total D/jpth 2 <br /> Depth to Water: ,� vWo� n• tt. <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction ( Blank Feet Screen Feet <br /> U Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> XTremie <br /> Filter Pack Type/Size: <br /> ElGravity ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags pallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 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 ` M,6 <br /> J <br /> 12.5 25 5 25 50 5 7 <br /> 15 30 6 30 60 6 I 1 <br /> 17.5 35 7 35 1 70 7 , <br /> 20 40 8 40 1 80 8 � cc (� ( � <br /> u)$- 1' u ��l�f y 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.s*cehd.com <br />