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SAN ,J OAQ U I N Environmental Health Department <br /> COUNTY- <br /> Greatness 3;0.. <br /> „ o <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Ib II �Il_ Inspector: i---- �iC CONSTRUCTION <br /> Premise Address: 1131 17:. mL-v- Alyj <br /> WP#: �903"�u0�' Total Depth: <br /> Well#: Drilling Rig Type: <br /> Soil Boring#: C>�,al. LLS Qc1��i All �S nul i �`� Min 2"Annular Seal Verified: El Yes ❑No <br /> Drilling Company: (,,A+wl �juo�As�^�3��„� <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Filter Pack From: To: <br /> Consultant: P�..�.�5-�..,,. F�,neer, <br /> Geologist: IjAA1'A N�^�fl`n Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO&FLETION coMPLEnoN <br /> Method: Ground Surf"' + � <br /> Screening Method: ofO"t <br /> Verified Chain of Custody: ElYes ❑No Ir — <br /> ft' <br /> tt. <br /> tt. <br /> SPOILS <br /> v _ e <br /> Contamination Noted: ❑ Yes ❑No '-" <br /> If yes, spoils storage Location: slotted 3 <br /> arc <br /> -.on <br /> Covered: ❑ Yes ❑No = gravel pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: __ <br /> IF <br /> Depth to Water: n• - n' <br /> Grout Material O t,6k P r wvv.Ar <br /> Gallons of Grout Used: -1.c . .,tAj(-s,q-� 1_z� MATERIALS/DEVELOPMENT <br /> `r— �— Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ,�� <br /> // Slot Size: <br /> Loring Installation [91 oring 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 /> L Gravity D 4emie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags <br /> 2.5 5 1 5 10 1 Bentonite/Cement Mix 3% Mix 5% Mix <br /> 5 10 2 10 20 2 Bentonite per 47 Ib 1.41 2.47 <br /> 7.5 15 3 15 30 3 <br /> 10 204 20 40 4 Bentonite per 94 Ib 2.82 4.7 <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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />