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SAN JOAQUIN Environmental Health Department <br /> —COUNTY- <br /> Greutness grows fit:,,' <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: // Inspector: P00 ri CONSTRUCTION <br /> Facility Address: Cr I — 2 7G w0 3 <br /> Well Address: �� 4-k 5"t Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: 614, B13. B4 . 64 B7 82 13! B6 <br /> �B150 84 i �� Min 2" Annular EHD Seal Verified: 11 Yes []No <br /> Drilling Company: turf QCc^ <br /> Driller Onsite:A-5 k G aa( <br /> Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: <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 casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONF LE'rION CCOOMPUEMN <br /> Method: Ground Surfscs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes []No —`--"ft' <br /> ft. <br /> tt. <br /> SPOILS Ke <br /> = m <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: alonee <br /> Covered: ❑ Yes ❑No _ VW <br /> If yes, material: _= <br /> GROUTING or STRUCTIO Total Depth: D t�� r =_ <br /> Depth to Wate . 1,l f 4 n' <br /> Grout Material: Wk ac.<<n <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Boring Destruction gags iz Cement: <br /> METHOD USED 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 Bas gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest tlBags Bentonite/Cement Mix 3% Mlx 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 z Bentonite er 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 50 5 s ,/Z bot 3 L"Sc n 7/&A <br /> 25 1 ' `t J <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 s ao so s � ' u),t,4,,r I t6 49 <br /> J 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br /> } <br />