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SAN JOAQUIN <br /> Environmental Health Department <br /> —COUNT Y <br /> °quP' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:2 13 Zo'W InspectorrDOW-;a A CONSTRUCTION <br /> Facility Address:• 4,ye4_ <br /> Well Address: Total Depth: �+S�t n r t <br /> WP# © Well#: Drilling Rig Type: <br /> Soil Boring#: 61 —9-6 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: %rq Gro <br /> Driller Onsite: d Screen Length From: To: <br /> Consultant:i <br /> Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> ttt <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLETION cCOMPLEnoN <br /> Method: around Suri"' <br /> Screening Method: groLd <br /> Verified Chain of Custody: ❑ Yes L1 No —`---n' <br /> it. <br /> tt. <br /> SPOILS - — <br /> ahContamination Noted: ❑ Yes El No a" <br /> If yes, spoils storage Location: �j2; ZO t .blmd <br /> Covered: El Yes El NoZ.. gravel pack <br /> r,�J I " <br /> If yes, material: N ► I <br /> GROUTING or DESTRUCTION Total Depth:��fl :'�S >� !• <br /> Depth to Water: F4 t <br /> Grout Material: /' QA LQ~ - MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 190 go,..{l0ea. <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation oring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity §zT•remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement941b <br /> allons Bas 2allons Ba s <br /> Thickest Thinnest i7 Bags Thickest Thinnest 8Bags 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 1 40 80 8 <br /> 130 )p,, d 0 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton California 95205 209 468-3420 F 209 464-0138 www.s6cehd.com <br /> I I I I l <br />