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SAN JOAQU <br /> Environm�,..,tal Health Department <br /> —COUNTY <br /> Greatness grov s - r. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �Z-13"��I Inspector: A E`E""` CONSTRUCTION <br /> Facility Address: Z7ey w' ✓`dabt.•a -Yb— <br /> Well Address: Total Depth: <br /> WP# oo i jo 1 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: J(/LV �la� n �_ Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: L"oslas Screen Length From: To: <br /> Consultant: Qo-.,6 -- Filter Pack From: To: <br /> Geologist: ( �^•�- <br /> 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 ABOVE-GROUND <br /> Holding Temperature: COWLEMON COMPLEfioN <br /> Method: Ground Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> fi. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: slotted <br /> an <br /> Covered: ElYes ❑No s� <br /> _ — gra„a pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ZA) <br /> Depth to Water: n• n' <br /> Grout Material: N4&' �'"�`y f <br /> 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 131Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ���� Type/Brand of Bentonite: <br /> L�Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 1tBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 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 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 ,1 pvyN t�rf.�/►� �i <br /> ,jM Gs 5.Vjj&k- is y Y d 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 />