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$AN-JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Q � '00 Inspector: k! I� <br /> A • CONSTRUCFION <br /> Facility Address: 1/V� Total Depth: <br /> Well Address: W- Drilling Rig Type: <br /> Wp#00,b 9 Well#: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> ii /•I Vy g Screen Length From: To: <br /> Drilling Company: To: <br /> Driller Onsite: / 'MIN ite From:-Wr, Filter Pack From: <br /> N V+ <br /> vt.$ ✓ o- TO: <br /> Consultant: Benton <br /> Geologist: <br /> � Grout From: TO� <br /> Public Water System Onsite: <br /> ❑Yes ❑No COMA Stove Pipe ❑Christie Box <br /> ❑Yes El No as®ing <br /> Domestic Well Onsi height <br /> If yes,location and <br /> distance: <br /> A130VF-6RC M0 CHniSTY•30X <br /> SAMPLING COWPLE iON compi.EnoN <br /> Holding Temperature: Ground Sartaa°_-- <br /> Method: grout <br /> 1 N. <br /> Screening Method: 4 �tt. <br /> ilV' / <br /> Verified Chain of Custody: ❑ Yes ❑No AlM W-L <br /> SPOILS �W�I� G <br /> ❑Yes ❑No ° 1 <br /> Contamination Noted: ��� <br /> If yes,spoils storage Location: � ' ° .°coon ?• = $ <br /> ❑Yes ❑No <br /> Covered: °fiBl ` <br /> If yes,material: <br /> a95 .5 = tt. <br /> GROUTING or DESTRUCTIa ITot7-D6 -f g, — <br /> Depth to Water: <br /> Grout Material: MATE R ELOPMENT <br /> Gallons of Grout Used: ^ a Casing Type: Feet <br /> S�,I✓�Q� Blank Feet Screen <br /> ❑Well Installation AWellDestruction I7�0� 11 Slot Size: <br /> ❑ Bags of Cement: <br /> Boring Installation ❑Boring Destruction gags Sand/Gravel: <br /> METHS Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Type of Method: <br /> 1�Gravity %,Tremie ❑Other: <br /> ent 941b <br /> Water Camen 471 Water Cemgas - <br /> 9a aliens BentonitelCeMnt Mix 3°/a Mix 5°/a Mix <br /> allons #Bags 1.41 •4 <br /> Thickest Thinnest #Bags Thickest Thinnest Bentonite er47lb <br /> 2.5 5 z 10 20 2 Bentonite er 941b 2•B2�^ ,.y/�4'7, �,/ <br /> 5 10 3 15 30 3 �� J l� QVd' <br /> 10 15 4 20 4° 4 ,�1�(n <br /> 10 20 25 50 5 vWI+V' <br /> 12.5 45 5 60 6 <br /> 6 30 //7sLS <br /> i55 35 7 35 700 8 ���, `, u '.� /2�_/+J <br /> 20 40 f,.�� Y'l <br /> 65 .9.1 1y scehd.corn <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 46$1- -?, Wort W0 5 I <br /> u�N.GQ,d <br />