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aQp,QLi/y C SAN JO f"f Q V I 1 <br /> COUNTY-- Environmental Health Department <br /> °9c�aowNP' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Dater 23 Inspector: POUld A CONSTRUCTION <br /> Facility Address: <br /> Well Add re f" VG>,-A or14 Pu Mp Total Depth: <br /> WP#oo? jqq `'0 — 2 Well#: 1 S�Pv'r Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: v'P�dtl !�. 'nY <br /> Driller Onsite: Screen Length From: To: <br /> P� �� ;, Filter Pack From: To: <br /> Consultant: <br /> A'L✓t,P�Z <br /> Bentonite From: To: <br /> Geologist: <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 AEKNE.GRpUND <br /> Holding Temperature: C06PLF-TION COMPIEnON <br /> Method: Ground Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No n' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r" <br /> If yes, spoils storage Location: <br /> asedon � '— <br /> Covered: ❑ Yes ❑No <br /> crags+pads <br /> If yes, material: r <br /> GROUTING or DESTRUCTION Total Depth: a! f < �� '• <br /> Depth to Water: n' <br /> Grout Material: t CP� -L4'z <br /> Gallons of Grout Used: s MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> �16ell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of 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 Ceme 47 b Water Cement 941b <br /> U2110 Ba Rallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest #Bags Bentonite/Gement 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 Bentonfte 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 /> 1,99� �S 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />