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_ 5°�cg SANsdOAQUIN Environmental Health Department <br /> COUNTY--- <br /> °9k, Greotness grows here. <br /> i� Monitoring Well/Soil Boring Inspection Report <br /> Date: J fl 79tt Inspector: (�V.C�S c �w,L CONSTRUCTION <br /> Facility Address: (2 I M e Allki!N,t, <br /> Well Address: Total Depth: J <br /> WP# 0 c '-\\oyL Well#: Drilling Rig Type: <br /> Soil Boring#: 19b <br /> Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: _ Cone Tc& Screen Length From: To: <br /> Driller Onsite: [v�`.�o. Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING A80V&GROUND <br /> Holding Temperature: cbWPLETION COMPLETION <br /> Method: Ground Surfs n <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: slotted <br /> soon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> p -' <br /> GROUTING or DESTRUCTION Total Depth: ���f-� s <br /> Depth to Water: %k n' <br /> Grout Material: 'La. <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation Boring Destruction Slot Size: <br /> 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 94 lb <br /> Rall s Bas eallons Bags <br /> Thickest Thinnest sBags Thickest Thinnest NBags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 is 30 3 <br /> 30 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 1 70 7 <br /> 20 40 8 40 1 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 />