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2°P SAN�JOAQUIN <br /> Environmental Health Department <br /> 1 <br /> --COUNTY-- <br /> Greatness <br /> —COUNTY--Greatness grows here. <br /> Monitoring'' Well/Soil Boring Inspection Report <br /> Date: <<f Inspector: Lr X",o CONSTRUCTION <br /> Facility Address: 17-11 S • W I I r-- ti Wow/ <br /> Well Address: Total Depth: <br /> WP# bJ394AT, Well#: Drilling Rig Type: <br /> Soil Boring#: 131, jp Z Q 3 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Go�&C'0& <br /> 9 C Screen Length From: To: <br /> Driller Onsite: 1 <br /> Consultant: ilter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: L. t')-, �e*bv-A�^ <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWF�TION COMPLEMN <br /> Method: Ground Surtacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No 1I, ft. <br /> n. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: .tottod <br /> aac5on — 8 <br /> Covered: ❑ Yes ❑Nogin,= �w i <br /> If yes, material: ax <br /> GROUTING or DESTRUCTION Total Depth: = IF_ <br /> Depth to Water: 0 n n' <br /> Grout Material: Atl&� c! MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:!:: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ri <br /> ong Destruction <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 /> ravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> gall s Bas gallons Bags <br /> Thickest Thinnest uBags 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 /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br />