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41 c SAN JOAQUIN Environmental Health Department <br /> —COUNTY-- <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: `I L} `� Ins�etor: khr�ee CONSTRUCTION <br /> Facility A dress: 3�VJ X77 CSC ivnd t� T <br /> Well Address: Total Depth: <br /> WP# U 0 Well#: Drilling Rig Type: <br /> Soil Boring#: C P T I � <br /> Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling p y:�d Q^F�Tyu Screen Length From: To: <br /> Driller Onsite: 1 U (A VV <br /> Consultant: 1 Filter Pack From: To: <br /> Geologist: de y"W tu 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: T height <br /> —wig <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION con,t�oN <br /> Method: Ground Sudw* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt. <br /> n. <br /> it. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: atortad <br /> on <br /> Covered: ❑ Yes El No N _ cnv+pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: "� n• — tt. <br /> Grout Material: CQ <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑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 E4remie ❑Other: Type of Method: <br /> Water "Cerhen071b Water Cement 94 lb <br /> allonsBas allons Bags <br /> Thickest Thi a Thickest Thinnest aBags 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 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 Be 8 <br /> 6'c" A�- 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />