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SAN. JOAQUIN Environmental Health Department <br /> -- <br /> Greatness grows here. <br /> C� Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 I t Ins ector: (�{' I� �A�kOik CONSTRUCTION <br /> Facility Address: er4or. <br /> Well Address: Total Depth: <br /> wP# O 019 0 56 Well#: Drilling Rig Type: <br /> Soil Boring#: 6 1 Min 2"Annular EHD Seal Verified: El Yes 11 No <br /> Drilling Company: t YI <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: I e' � �I^ Filter Pack From: To: <br /> Geologist: /0" O�YI Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 1:1 No ---���ttt--- casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLEMN �1.EnoN <br /> Method: Gnwnd Sa face co <br /> Screening Method: groLA <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> n. <br /> tt. <br /> SPOILS Y <br /> ,a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: bets" M! . <br /> a.c9on <br /> Covered: ❑ Yes ❑No =_ <br /> _ Brawl pads <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:90-F —_ <br /> Depth to Water: M n' n' <br /> Grout Material: Q61. <br /> Gallons of Grout Used:�� Ions MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Woring Destruction Bags of Cement: <br /> METHOD USED A/Yl>Z 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 Cemen 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 3% 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 1 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 /> �'5 9011 !� aqS 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />