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SANJOAQUIN <br /> Environmental Health Department <br /> (,I —COU <br /> NTY— <br /> `4cr�oP' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: cGT-71 POEM CONSTRUCTION <br /> Facility Address: 11Q0 HUmrrre,�,^ , 1:-tQ0Kton <br /> Well Address: Total Depth: <br /> W P# CIOlli Well#: Drilling Rig Type: <br /> Soil Borin #: 2-CP-f-11 2-GPT` Zd , 2-Cf-T- 11 <br /> g Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: 6+20-W SyMQTFUCQ Pyr101(ftri <br /> Driller Onsite: FrlE?Q.4Q Screen Length From: To: <br /> Consultant: Gan�L11 -Fl�frllfl9 Filter Pack From: To: <br /> Geologist: RgQI�►Kq 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 El No casing <br /> If yes, location and distance: height: <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONF�IoN coMPLEnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> SPOILS <br /> lei. a <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: CPT 21 9C1 ,lotted W 8 <br /> on <br /> Covered: El Yes ❑No GPT 2U 5(o, a„ = g-11 Pack <br /> If yes, material: GPT 11 52.E ` <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 11' _ n• Jt. <br /> Grout Material: NQQ-t CQn 0't <br /> Gallons of Grout Used: 1 a MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation inti <br /> pBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity 41Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest it Bags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 z 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 1s 30 3 <br /> 10 20 4 20 40 4 <br /> is zs 6 zs 50 s bQg S lb C+2111e�f <br /> 15 30 6 30 60 6 �- <br /> 17.5 35 7 35 70 7 �J <br /> 20 40 8 40 80 8 14 gQ��Vns' wG1 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />