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"c�, SKJOAQUIN <br /> �' Environmental Health Department <br /> —COUNTY— <br /> �59„FQaN"' Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: M + ILL (Inspector: C'�avrvxs CONSTRUCTION <br /> Facility Address: (, <br /> Well Address:_ _ _ Total Depth: <br /> WP# nbt� kq 2\ Well#: Drilling Rig Type: <br /> Soil Boring#: WA Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: q lkw �)rikV(4 <br /> Driller Onsite: � �\[.., Screen Length From: To: <br /> Consultant: ( Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING ASovE-GROUND <br /> Holding Temperature: CONFLETION CCCAAPLEnON <br /> Method: Ground Surface <br /> Screening Method: grocA <br /> Verified Chain of Custody: ❑ Yes El No �---n' <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> - C <br /> If yes, spoils storage Location: atoll <br /> an — <br /> Covered: ❑ Yes ❑No = 9-61 Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: • — <br /> Depth to Water: tt. <br /> Grout Material: �" 'Y`�11- <br /> Gallons of Grout Used: •'V � MATERIALS/DEVELOPMENT <br /> • � `� Casing Type: <br /> ❑Well Installation ❑Well Destruction titi'°`'` '' Blank Feet Screen Feet <br /> !� U�U?�`" Slot Size: <br /> ❑Boring Installation S.Boring Destructi n % <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> �i 0 Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill �� <br /> N`'j,� 6�. Filter Pack Type/Size: <br /> ❑ Gravity Wremie ❑Other: _ Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest 1r Bags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix S% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />