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SAN�JOAQUIN p <br /> Environmental Health Department <br /> COUNTY— <br /> �`-F9y_,epN"� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: //-g-2-3 Inspector: A CONSTRUCTION <br /> Facility Address: W60 my, 1y $ <br /> Well Address: ��/T Total Depth: <br /> WP# *Z� 7 z/r 2q Well#: SB e Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: 'e, <br /> Driller Onsite: �. Screen Length From: To: <br /> Consultant: wf Filter Pack From: To: <br /> Geologist: '�Mlowe 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: IffT height <br /> I <br /> SAMPLING ABOVE-GROUND <br /> COMPLETION C -Box <br /> Holding Temperature: cOMPLEoMPlenoN <br /> Method: cNoundsutao. "�'-- <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑Non. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: Monad I.y <br /> sac7on 1 = 8 <br /> Covered: ❑ Yes ❑No — <br /> gnvel Pads <br /> If yes, material: Q c! c <br /> GROUTING or DESTRUCTION Total Depth; <br /> Depth to Water: ?0 <br /> Grout Material: Pv <br /> Gallons of Grout Used: //u� 9 LOr+d MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Nell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <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 kkTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest xBags Thickest Thinnest aBags _ Bentonite/Cement Mix 3%Mix 5a/a Mix_ <br /> 2.5 5 10 1 lBentonite per47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 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 a 40 BO 8 <br /> 10/16/2017 <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />