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tCulN <br /> 2 ;c°Z SA6JOAQUIN Environmental Health Department <br /> Q r+"•I `,' —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> ✓Date: 7hqbg vinspector: om HOM CONSTRUCTION <br /> ✓Facility Address: <br /> Well Address: Total Depth: <br /> ✓/WP# Q �$ <br /> 0 52 Well#: Drilling Rig Type: <br /> V Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> V,'DrillingCompany: atco <br /> Driller Onsite: ej r (; Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> ✓ Geologist: I s <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No Y casing <br /> If yes, location and distance: I height <br /> SAMPLING AW VE•GROUND <br /> Holding Temperature: COMPLETION CC#APt.FnoN <br /> Method: Ground Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: 510 P14 <br /> sloned <br /> Covered: ElYes ❑No I I s 10 a.�n <br /> If yes, material: <br /> ROUTING or STRUCTION otal Depth: a. =_ <br /> IF <br /> Depth to Water: n� n• — 1ti. <br /> 'Grout Material: V\0A CCrAe L <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation>16oring Destruction '� gags 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: Typeof Method: <br /> Water Cement 471b Water Cement 941# <br /> allons Bas gallons Bas J L <br /> Thickest Thinnest ft Bags Thickest Thinnest #Bags 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 <br /> 10 20 4 20 40 4 <br /> 1 25 5 25 50 5 7 <br /> 155 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 !!! J <br /> 20 40 a 40 80 e <br /> 20 asml : 3q <br /> 00k : C D 4 4 bis = /,,)-13 34,5 S 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s*cehd.com <br /> C Is g+) 5 bass +o �p ,4U•K, <br />