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N SAN<JOAQUIN Environmental Health Department <br /> _ --COUNTY--- <br /> �y-=�' <br /> c'crFoaN.P' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report add , �'tns <br /> Date: Inspector: A1W&e'er CONSTRUCTION <br /> Facility Address:&*&/g � <br /> Well Address: Total Depth: <br /> WP# pD3 f ykq Well#: Drilling Rig Type: <br /> Soil Boring#: 2 2 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 'Pere ccy,&- <br /> Driller Onsite: 'fvar... Screen Length From: To: <br /> Consultant: /,sd5tn -I�� Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: /�f� <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No I casing <br /> If yes, location and distance: T height <br /> SAMPLING ABOVE-GROUND CHR _ <br /> M <br /> Holding Temperature: COWLETiON COMPLETION <br /> Method: Gnxind Surf=* <br /> Screening Method: 0 <br /> grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> ft. <br /> SPOILS r <br /> Contamination Noted: ❑ Yes El No — <br /> If yes,spoils storage Location: abed <br /> aKSon <br /> Covered: ❑ Yes ❑No = 9 V, <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: :9d <br /> Depth to Water: 30 <br /> tt. ft. <br /> Grout Material: /✓� Geis"L`*� <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation,%Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity §1Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bags gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest uBags 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 z 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 7 6-A s N7/4 ZZ!- J`'e/tO- 14Z'e7 <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 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 J www.s'cehd.com <br />