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$QN JOAQUIN t Envirorl ltl.al Health Department <br /> —COUNTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: lU 12 UW Inspector:(At)m lxndMcj CONSTRUCTION <br /> Facility Address: V <br /> Well Address: lurk 7 A10,fla W Total Depth: <br /> tt: <br /> Wp# V a V0y Well#: /iC A T Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> fQbbQ�{ t Screen Length From: To: <br /> Driller Onsite: <br /> � T� t.����n �T11�QX Filter Pack From: To: <br /> Consultant: <br /> Bentonite From: To: <br /> Geologist: Grout From: To: <br /> Public Water System Onsite: ❑Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVEGROUND OtigISIY eOX. <br /> Holding Temperature: COh1PLEfION cOMPLEn.ON <br /> Method: Ground 8u1an <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑Yes El No h; <br /> SPOILS <br /> h = <br /> Contamination Noted: ❑Yes ONOif yes,spoils storage Location: <br /> atction � _ <br /> Covered: ❑ Yes ONO ^ = y, gPagc <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: A. <br /> PXY1 <br /> Depth to Water: fL &� tt. <br /> Grout Material: Cem� L 4Y lb 12 tis <br /> _ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation SdWell Destruction Wr?II Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED �x��Qs\t( t Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ,Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags allons Bags _ <br /> Thickest Thinnest 9Bags Thickest Thinnest ltBags 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 2 20 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 A 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 s0 5 <br /> 1s 3D 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 1 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 1 www.s'cehd.com <br />