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SAN-JOAQUIN <br /> 77 Environmental Health Department <br /> _ i —COUNTY <br /> C:reatness groes here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: WFJIX Inspector: LoL;72y)( CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> W P#- 003lj17%4 0 Well#: Drilling Rig Type: <br /> Soil Boring#: $,IS.o23,aI Lg1& 4)J 13z1A—L-Z'-r6tt1, Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Mein Filter Pack From: To: <br /> Geologist: ASo�� <br /> 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 T_ casing <br /> If yes, location and distance: hea.ght ; <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 00&FLE ION CCUPLEriON <br /> Method: Gmund Surfxa <br /> Screening Method: a*� <br /> Verified Chain of Custody: ❑ Yes ❑No f- <br /> ft. <br /> n ft. <br /> SPOILS 3i�•�b IJ �J Z3 J 16J ( a�- _ a . <br /> Contamination Noted: ❑ Yes ❑No <br /> Ifyes, spoils storage Location: <br /> ss�an <br /> Covered: ❑ Yes ❑No 'w <br /> Ifyes, material: <br /> GROUTING or DESTRUCTION Total Depth: Z��k,3 �3 ,3ofk�toP6�2o� <br /> Depth to Water: to 14'- - FIF <br /> '— ' <br /> Grout Material: r' <br /> Gallons of Grout Used:ti MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑lWWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation S Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ,,Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bas gall ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest IBags Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2,47 <br /> 5 10' 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 i <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 'J1 <br /> 17.5 35 7 35 70 7 If <br /> 20 40 6 40 80 8 <br /> r zoy 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T' 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />