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=°�°u1"°z SAN,,JOAQUIN <br /> Environmental Health Department <br /> " COUNTY— <br /> Greatness <br /> OUNTYGreatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z�3 2 Inspector: SUKh'Mc+ CONSTRUCTION <br /> Facility Address: 13� �TLkvnaX <br /> Well Address: Total Depth: <br /> WP# 00 Well#: Drilling Rig Type: <br /> Soil Boring#: � <br /> Drilling Company: V J Min 2" Annular EHD Seal Verified: El Yes []No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: rN <br /> Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes EJ No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING —aw, <br /> ABOVE-GROUND _ <br /> Holding Temperature: COWLErION coMPLEnoN <br /> Method: Ground Surface <br /> Screening Method: ori <br /> Verified Chain of Custody: ❑ Yes E]No �ft' <br /> n. <br /> SPOILS . <br /> e <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stotma <br /> axion <br /> Covered: ❑ Yes El No = VW <br /> PaCK <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: NQ C W l n• n' <br /> Grout Material: T&W (.Y.yyVA<51 <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation-*Boring Destruction 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Ba Rallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest ttBags <br /> 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 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> I`pboj.�94, VQ W rbc r" ptr 10/16/2017 <br /> c <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />