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SAN JOAQUIN Environmental Health Department <br /> —COUNTY-- <br /> Greatness grows here. <br /> 2 Monitoring Well/Soil Boring Inspection Report <br /> Dater 2✓ Inspector: A 4 CONSTRUCTION <br /> Facility Address: <br /> Well Address: t-.-Oe ve'r- `3 ov��j �u#^� Total Depth: <br /> WP#00 ? —7i0 — "2 Well#: '�T S�P�'r' Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: ��tl `r SKY <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: e* (o p 1 - �- Filter Pack From: To: <br /> a•'Lr7.PR• <br /> / Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes L1 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-3AoLWD <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Ground Surface <br /> Screening Method: grCLt <br /> Verified Chain of Custody: ❑ Yes El No 1 n. <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: abnad = 3 <br /> sacdon _ <br /> Covered: ❑ Yes El No = grave,Pack <br /> If yes, material: rL <br /> GROUTING or DESTRUCTION Total Depth: T l _ <br /> Depth to Water: 7f n. n. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: s <br /> Casing Type: <br /> D1Nell 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 /> allons Ba laall ons Bags <br /> Thickest Thinnest #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 BentonRe per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 204 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 /> 10 40 8 40 80 8 <br /> 1� 1 NQS 10/16/2017 <br /> 18(68 E. Hazelton Avenue I "'Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s*cehd.com <br />