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SA N J DAQ U I N Environmental Health Department <br /> COUNTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Q 1 W 26 Inspector: Q ` CONSTRUCTION <br /> Facility Address. 26k C)( XC CCU r _ ( . I <br /> Well Address: Total Depth: wt�,,. L ' <br /> WP# 2f")(7\j1(6 Well#: Drilling Rig Type: n ✓ <br /> Soil oring#: S1{" " I �Sr <br /> Soil <br /> Drilling Company: ` Min 2" Annular EHD Seal Verified: f4 Yes El No <br /> pany: \�V�If�G� k� <br /> Driller Onsite: iC Screen Length From: To: <br /> Consultant:�n , spxy as, Filter Pack From: 1k 5 To: 5-15� II � <br /> Geologist: Bentonite From: �' To. ''+"� a'�� <br /> Grout From: t To: 0,$ GA �✓ <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe KChristie Box VA4ZA <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO�"¢'�fON cnCHRLSTYoN <br /> Method: Ground surixs <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes El No <br /> �n' <br /> ft Cekc.o <br /> SPOILS <br /> m _ <br /> Contamination Noted: ❑ Yes El No � iiOPb. <br /> If yes, spoils storage Location: stoned = <br /> sacdon <br /> Covered: ❑ Yes ❑No = g-91 <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n• <br /> Grout Material: N 2A C1n tt A, l ► S C�OIU� �X�u� <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT �L � ®`b, <br /> Casing Type: J <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 94lb <br /> gall Bags gallons 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 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 /> 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 />