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S Q N J OAQ U I N Environmental Health Department <br /> COUN i Y <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 111011-,(o Inspector: V-V •- / CONSTRUCTION <br /> Premise Address: c(.( <br /> WP#: W Total Depth: <br /> Well#: G­W Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Cirtu <br /> DrillerOnsite: 'Iff il, � 1� Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist:�{ C�lY1a.11 ,�� Bentonite From:. Il�b To:_ cl�C; <br /> Grout From:y f 0 To: k%C <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 ASOyE..GRO;o <br /> Holding Temperature: COWLEMN cCot,�let�iloN <br /> Method: Gmjnd sut"' + '_ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑No �c /> Ic fiv <br /> ...�it. <br /> SPOILS <br /> x;. <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: sicrmd <br /> Covered: ❑ Yes ❑No =r = <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: -ft. n• <br /> Grout Material:gw'^AML14� W l/i t ~I' MATERIALS/DEVELOPMENT ,-tiny' oup : 22,0 4- <br /> Gallons of Grout Used: gaja1 (�1 brIAJnS) Casing Type: f4 C An Awy(,{('r <br /> )(Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: &LA ( 41 tL (+aAi (ige (iik i ft �I�+ <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: 44\llnpjU5 M(ALufn ((;OIL <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity `�remie ❑Other: Type of Method: <br /> Water Cement471b Water Cement?4 lb jog QfApt M j)(eA <br /> gallons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 4Bogs <br /> 2.5 5 1 5 10 1 Bentonite/Cement Mix 3% Mix 5% Mix <br /> 5 10 2 10 2D 2 Bentonite per 47 lb 1.41 2.47 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 Bentonite per 94 lb 2.82 4.7 <br /> 12.5 25 5 25 50 5 <br /> 15 3o 6 30 6D 6 <br /> 1Z5 35 1 7 35 1 70 I 7 <br /> 20 40 8 4D 10 8 <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />