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?' SAWJOAQUIN Environmental Health Department <br /> —COUNTY----- <br /> Greatness grows here <br /> I Monitoring Well/Soil Boring Inspection Report <br /> Date: '(FIZZ Inspector: bra CONSTRUCTION <br /> Facility Address: (dga,'R Lo Lw C_ <br /> Well Address: r ti Total Depth: <br /> WP# A Well#: Drilling Rig Type: <br /> 7_1nSoil Boring#: l7 �6 D Zt> ZXc t- 021 „ <br /> Drilling Company:� vv 2,-- 1 Min 2 Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: �L Xv% J- Screen Length From: To: <br /> Consultant: �G� Z 1✓ yv�•��{. Filter Pack From: To: <br /> Geologist: t7 +a w,.0Wi'Z Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes JD d COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ElYes ",LJNo casing <br /> If yes, location and distance: height <br /> SAMPLING ASOVE-GROUND <br /> Holding Temperature: COWPLETION cotitPLETIoN <br /> Method: Ground Surfacs '+ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> n. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: .toned <br /> a 'on <br /> Covered: ❑ Yes ❑No - tack <br /> If yes, material: k <br /> GROUTING or DESTRUCTION Total Depth:Z� , <br /> Depth to Water: A294 — tt' <br /> Grout Material: VVLAA— <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Sorin Installatio ��,,,,,�� Slot Size: <br /> g rl�tsoring 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 /> 0 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas Rallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags 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 h5 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.s*cehd.com <br />