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SAN ,JOAOUIN <br /> —COUNTY-- Environmental Health Department <br /> ",O:i, P' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: h 1� Inspector: S �"rtt CONSTRUCTION C f�7 <br /> Facility Address: _ �E0 5 1)1 a r`l� `� <br /> Well Address: Total Depth: <br /> WP# 0!jo U i R Well#: Drilling Rig Type: <br /> Soil Boring#: CPT I Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: G <br /> Driller Onsite: o rCi Pi Screen Length From: To: <br /> Consultant: U,I t�q'(t°1'1, Filter Pack From: To: <br /> Geologist: j 0(', <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING AMOVE-GROUND <br /> Holding Temperature: CONFLETtoN CO&Un-EnoN <br /> Method: Ground Surfact' + <br /> Screening Method: aorout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> it. <br /> tt. <br /> SPOILS = <br /> o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: •bned <br /> an <br /> Covered: ❑ Yes El No _ t-w+P-24* <br /> If yes, material: s` <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: t n' <br /> Grout Material: ot <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation �Zoring 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 /> ❑ Gravity remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izallons Ba s <br /> Thickest Thinnest #95-FThickest Thinnest uBags 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 1 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 1 40 8 40 80 8 <br /> 11 ►� S v�1 J 5 0� ,t`nd w aj-4- 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />