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SA N hJ OA Q U I N Environmental Health Department <br />COUNTY <br />p <br />Greatness grows here. <br />Mon <br />itoring I,Well/Soil Boring Inspection Report <br />Date: /Z) Inspector: J � S � t(ll,,i CONSTRUCTION <br />Facility Address: l ' S , ��� %fC� dam`. 2► e-- in <br />Well Address: Total Depth: <br />a P.1 or 4 'l �y � Well#: 5 b _ �i-1 3 Drilling Rig Type: <br />Soil Boring#: <br />Min 2" Annular EHD Seal Verified: 11 Yes El No <br />Drilling Company: <br />Driller Onsite: Screen Length From: To: <br />Consultant: t 6t -Filter Pack From: To: <br />Geologist: P j Ch-4-�'e -)LVLA h+-- 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: height <br />SAMPLING ABOVE -GROUND <br />Holding Temperature: COMPLEDON comp CMCN <br />Method: Grvund Surfacs <br />Screening Method: grout <br />Verified Chain of Custody: ❑ Yes El No .eft. <br />tt. <br />ft. <br />SPOILS — <br />Contamination Noted: ❑ Yes El No — <br />If yes, spoils storage Location: slan�d <br />sacaon = 3 <br />Covered:CC��'' t� _/ -NYes 11 No <br />V <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: i S <br />1s'�s'- <br />Depth to Water: o "te- C. '1^ LO' n. tt' <br />Grout Material: 71e4'r ��n�. <br />MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: 6-1 g r qCasing Type: <br />r <br />❑Well Installation []Well Destruction Blank Feet Screen Feet <br />❑Borin Installation Slot Size: <br />g Boring Destruction 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 ❑Tremie ❑Other: Type of Method: <br />Water <br />gall s <br />Cement 471b <br />Bas <br />Water <br />Rallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />«Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 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.s4cehd.com <br />