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'SAN JOA UIN <br /> Z Q Environmental Health Department <br /> —COUNTY— <br /> Greatness Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I Inspector: 0'/"/A 14- CONSTRUCTION <br /> Facility Address: a (�, �J <br /> Well Address: ` rTotaI Depth: <br /> WP# DoKD2 Well#: Drilling Rig Type: U <br /> Soil Boring#: 1 — Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �I/ <br /> I 16A _Kw 0 Filter Pack From: To: <br /> Geologist: '50'e- Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No r I casing <br /> If yes, location and distance: b height <br /> VV 116 T�if <br /> os" R M_ —Ww-f <br /> SAMPLING 6/t ABOVE-CaROMD <br /> Holding Temperature: i �t'���N CCOMPE'En'ncN <br /> Method: 5 6 ► around Surf <br /> Screening Method: �6 grout <br /> Verified Chain of Custody: ❑ Yes ❑No` j' 6� ✓�`,' �it' <br /> SPOILS <br /> pq, $ <br /> Contamination Noted: ❑ Yes ❑No pro,9, <br /> If yes, spoils storage Location: q: 6 sbtu+d ; <br /> DIS. 6 D ,,.ten = B <br /> Covered: 11Yes ❑No / ��. pack <br /> If yes, material: ��Z. l�' = �� <br /> GROUTING or DESTRUCTION Total Depth: 6 P D►3: <br /> c <br /> Depth to Water: ��y•58 n' <br /> Grout Material: <br /> Gallons of Grout Used: 490 qMATERIALS/DEVELOPMENT <br /> e4 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation g Slot Size: <br /> �BOrin Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> u Filter Pack Type/Size: <br /> �13 Gravity '1Trklie ❑Other: Type of Method: <br /> �! ti <br /> Water Cement71b Water Cement 941b <br /> gallons Bas allons Bags <br /> Thickest Thinnest pBags 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 1 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 1 25 5 25 50 5 <br /> 15 1 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 1 80 8 <br /> S5 100j 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209468-34201 F 209464-0138 1 www.s6cehd.com <br />