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SAN J OAQ U I N Environmental Health Depar°trnen�; <br /> —COUNTY— <br /> ��reo;.ness c?: <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 ( Inspector- r N 0 CONSTRUCTION <br /> Facility Address: �° S c , 'r P—j eyitpCq <br /> Well Address: Total Depth: <br /> WP# 90.1? l Well#: Drilling Rig Type: <br /> Soil Boring#: V–In Min 2"Annular EHD Seal Verified: ❑ Yes Ll No <br /> Drilling Company °1 — ) <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: COMPLET)ON COMPLET]ON <br /> Method: G=nd SLxf=s <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS — <br /> _ a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> tictud — C <br /> Covered: ❑ Yes ❑Nogravol= I <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Tot Depth: <br /> Depth to Water: IF — IF <br /> ft <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: "^ Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation WBoring Destruction Slot Size: <br /> ���� Bags of Cement: <br /> METHOD USED 7jS Ih1j OL' $DGt Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Dr i , ' "I' L u Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity llTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Baas <br /> Thickest Thinnest 4Bags Thickest Thinnest "Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 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 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 Q <br /> 15 30 6 30 60 6 �'(�1�k) , �,ti,�1 �{ CQit'Z4 <br /> 17.5 <br /> as 7 35 40 8 40 0 <br /> 0 3 �Q <br /> 01 /16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s*cehd.com <br />