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SAN.PJOAQUIN Environmental Health Department <br /> COUNTY— <br /> ��O,r, T Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:. Inspector: t)GLV5 - CONSTRUCTION <br /> Facility A ress: 2o_to 4(-&Vlt L\kry_ I 1VO-0 <br /> Well Address: _ _ Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: B3 <br /> Drilling Company: �rG2an "fG'O M�ca.t y�.i Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> �- Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: kng}Dln '�I\�� QY. 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: COMPLETION 0OMPtEMN <br /> Method: GnxineSuri"' + <br /> Screening Method: groLn <br /> Verified Chain of Custody: ❑ Yes El No I--n' <br /> ts. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes 11 No <br /> Al <br /> If yes,spoils storage Location: ebned ; <br /> section <'• — <br /> Covered: ❑ Yes El No _ g-w+p--k <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 041 IF : =_ <br /> IF <br /> Depth to Water: n• n' <br /> Grout Material: v +- <br /> Gallons of Grout Used: 10 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation []Well DestructionIbb0.uS Blank Feet Screen Feet <br /> ❑Boring Installation KBoring Destruction )k 1Z Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill A, Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: �D Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest $1Bags Thickest Thinnest 11 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 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 1 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 />