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SAN-IOAQUIN <br /> Environmental Health Department <br /> - COUNTY-- <br /> `�a�rP` Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: MInspector: \i CONSTRUCTION <br /> Facility Address: L 18C � <br /> Well /address: _ Total Depth: <br /> WP# ()nu1\ Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Vj • 1 i <br /> Driller Onsite: L Screen Length From: To: <br /> Consultant: '`_(- Filter Pack From: To: <br /> Geologist: Qb 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 ABOVE-GROUND <br /> Hol&ng Temperature: COMPLETION ciFnON <br /> Method: Ground Sudac* <br /> Screening Method: or«n <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> it. <br /> ft. <br /> SPOILS <br /> v — a <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: abn�d <br /> section <br /> Covered: ❑ Yes ❑No = i <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: `� yy 1. -_ <br /> Depth to Water: (10 ujaktx-. n. w t. <br /> Grout Material: NO— CkObjAV MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ✓V)l5 Gt[, ' <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation V4Boring Destruction � y\ <br /> 7 � Bags of Cement: <br /> METHOD USEDk J;�a Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill J` Type/Brand of Bentonite: <br /> £ r_)N I-) p� Filter Pack Type/Size: <br /> ElGravity Wremie ❑Other: `` '1�' �� Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> allons Bas gallons Satzs <br /> Thickest Thinnest Jt Bags Thickest Thinnest 4Bags 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 8 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 />