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SA N J OAQ U I N . Environmen�, Health Department <br /> COUNTY— <br /> . <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: Lo, � �' CONSTRUCTION <br /> Facility Address: tLct <br /> Well Address: Total Depth: <br /> WP#d0.7-1 qYy Well#: Drilling Rig Type: <br /> Soil Boring#: &tlko Leo <br /> P-u�cc�ra B.�dl Min 2" Annular EHD Seal Verified: El Yes []NoDrilling Company: <br /> Driller Onsite: 71w..... Screen Length From: To: <br /> Consultant: Gcvs�A Ae- Filter Pack From: To: <br /> Geologist: .S"ioi 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: COWLEDON ccotptEnON <br /> Method: Ground Surf=* <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes El No <br /> fi. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: sbn�d <br /> sac9on _ <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ _ <br /> Depth to Water: L0151T <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 [go Slot Size: <br /> ring 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 Premie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall Bags gallons Bags <br /> Thickest Thinnest ttBags 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 /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 1. 20 4 20 40 4 �� I <br /> 125 25 5 25 50 5 YG <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 J Z_� `i 6 � /� p <br /> If 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.s6cehd.com <br />