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SAN. IOAQUIN Environmental Health Department <br /> —COUNTY— <br /> } I:b, Greatness grows here. <br /> II 2- 10&0jq Monitoring Well/Soil Boring Inspection Report <br /> Date: �L l &rt Inspector: N a CONSTRUCTION <br /> Facility Address: Z �` <br /> per- �� � <br /> 4 <br /> Well Address: Oeft{t Total Depth: �� IIq t� <br /> WP# O q0 I Well#: Drilling Rig Type: <br /> Soil Boring#: 2 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: t7 U ' 4 1 <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: _ �� Filter Pack From: To: <br /> Geologist: +�' 1 Bentonite From: To: <br /> 1 -----From: To: <br /> Public Water System Onsite: ❑ Yes ❑No s kgr—c OMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: 0`— Z4} height <br /> SAMPLING ' r`r ABOVE-GROUND ct rYBox <br /> Holding Temperature: 1 � �1ON ss <br /> COMPtEMN <br /> Method: I ontnd sufx. <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes ❑No 6S5'b ft. <br /> t ft. <br /> . <br /> ft <br /> SPOILS � �F w <br /> Contamination Noted: ❑ Yes El r <br /> If yes, spoils storage Location: <br /> a <br /> s{onad <br /> s+cdon Y` <br /> Covered: ❑ Yes ❑No <br /> g-vw pack <br /> If yes, material: ` = <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: e 7 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation Xwefl Uestruction beY��� �M Blank Feet Screen Feet <br /> ❑Boring Installation ❑ M� Slot Size: <br /> Boring Destruction I�L <br /> (ek *J,4'P Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> � ,c <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout `)(Over Drill Filter Pack Type/Size: <br /> ❑ Gravity Xremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> gall Bags ealions Bags <br /> Thickest Thinnest NBags Thickest Thinnest 4Bags 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 lb 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 /> 20p� <br /> 17.5 35 7 35 70 7 J' <br /> 20 40 8 40 80 - 8 - - �V ✓'1 ��� <br /> \ 1 2017 rae <br /> 1868 E. Hd"e Av e Stockton, alif 95205 —209 6 -3 Y� =013 com <br /> C <br /> jb � - 3b s 25b. <br />