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z SAN JOAQUIN Environmental Health Department <br /> " i= --COUNTY -- <br /> a Greatness grows here. <br /> l Monitoring Well/Soil Boring Inspection Report <br /> DateiQ�[_Zo Inspector: .'/D`�'1c O CONSTRUCTION <br /> Facility Address:S Qi k1Q io►' Y <br /> Well Address: l�61 L&"V f1'" Otal Depth: <br /> WP#009 12YI Well#: — r,W-2 Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes 0 N <br /> Drilling Company: C&SS Screen Length From: To: <br /> Driller Onsite: P <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 ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: �n_ —CrWT <br /> T height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLEr10N coPLEnoN <br /> M <br /> Method: Ground Surface <br /> Screening Method: grotA <br /> Verified Chain of Custody: ❑ Yes El No �ft• <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slanad <br /> sacdan <br /> Covered: El Yes El No _ t-w+pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: o• <br /> Casing Type: <br /> ❑Well Installation 'KWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Bolring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> SSA 9 Type/Brand of Bentonite: <br /> ❑Pressure GroutQver Drill Filter Pack Type/Size: <br /> ❑ Gravity "�Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Bas Izallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 /> DA !`al 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />