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�QpQUIry Com,, <br /> SA N J 0 A 0 U I N Environmental Health Department <br /> —COUNTY— <br /> �`Slr. Greatness grows Gere. <br /> Monitoring ,W1 ell/Soil Boring Inspection Report <br /> Date:��I$f�7p Inspector: f;Zpj r ell CONSTRUCTION <br /> Facility Address: tg7C; S ,I��SCQ�l �jUil�l�o� (tr1�l�, r <br /> Well Address: Total Depth: <br /> WP# w" (3 p cr /GG c./ Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drillingta'ie Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Company:p y' PiJ (v �����w6 �r-L <br /> Driller Onsite: 0& ✓1 Screen Length From:Y7C2 To: c, <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: f, To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION 10 Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLETtoN <br /> Method: Ground Surfacs + _ <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes 11 No <br /> ft. <br /> ft. <br /> SPOILS . <br /> v O <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stottad e <br /> sacdon %•: — <br /> Covered: ❑ Yes ❑No . <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ?&o <br /> Depth to Water: 11;C) ft. ft' <br /> Grout Material: jet.p(_ _ <br /> Gallons of Grout Used:'10 u 3 ��nhm2c MATERIALS/DEVELOPMENT <br /> ��� Casing Type: <br /> VWell 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 VTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest tJBags Thickest Thinnest pBags 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s*cehd.com <br />