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SAN JOAQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:���\\�' �y� Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: d& Total Depth: <br /> WP# Q\\Z.33-1- Well#: P�IIing Rig Type: <br /> Soil Boring#: <br /> Drilling Company: lsNcrsz� - �'ti Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: N%��-�-- M�\N�r�y_ Screen Length From: To: <br /> �A � t <br /> Filter Pack From: To: <br /> Consultant: -C <br /> Geologist: L'b'tC Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: 11 Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: 17 height <br /> SAMPLING ,,j\4P AWVE-GROUND <br /> Holding Temperature: cohiPLEr10N CoMPoN <br /> Method: Gmnd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ElYes ❑NoVA <br /> y' <br /> ft. <br /> ft. <br /> SPOILS <br /> � = o <br /> Contamination Noted: ❑ Yes ❑No ` <br /> If yes,spoils storage Location: stoned <br /> socZon <br /> Covered: El Yes ❑No = g-vwpack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: V-6�)'— 4. = <br /> Depth to Water: IF S _ I IF A. <br /> Grout Material: k- � MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: \loci <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation [horing 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 $[,Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest tlBags 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 80 8 <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 />