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SAN'10AQUIN <br /><• Environmental Health Department <br />`i —COUNTY— <br />Greatness grays Farr.. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /I3I2� Ins ector: (S'tk CONSTRUCTION <br />Facility Address: 2.3 f"o ZI-, <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: - D S <br />Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: O,, Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes [_1 No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes []No <br />casing <br />If yes, location and distance: height <br />SAMPLING <br />ABOVE -GROUND ctiHssTr-eax . ' <br />Holding Temperature: COW'LETION COMFLEnON <br />Method: Ground Surface <br />Screening Method: grout <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS tt. <br />Contamination Noted: ❑ Yes ❑No =� <br />If yes, spoils storage Location: atattQo a = .E <br />Covered: ❑ Yes EJ No }` <br />,� -- gnwt pac5c <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: S Q- UU <br />Depth to Water: o 41 e. eMn- <br />Grout Material: Geri -T <br />Gallons of Grout Used: '�- --- <br />S MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br />❑Sorin Installation Slot Size: <br />g Boring Destruction Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br />1<6ravity ❑Tremie ❑Other: Type of Method: <br />Bentonite/Gement Mix 3°/_a_Mix _ 5_ % Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <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 />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />k Bags <br />Thickest Thinnest <br />x Bags <br />2.5 <br />1 5 1 <br />1 <br />5 <br />1 10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />30 <br />8 <br />Bentonite/Gement Mix 3°/_a_Mix _ 5_ % Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <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 />