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SANJOAQUIN Environmental Health Department <br /> -COUNTY <br /> "Pql, �' Greotness grows her,. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: AAsr6-1"' CONSTRUCTION <br /> Facility Address:il.oz,{ ryz,5- X- e. k, - e <br /> Well Address: Total Depth: <br /> WP# r�o JZ 551 Well#: e*W Drilling Rig Type: <br /> Soil Boring#: Cpl'-jt3 c-p7-3 C <br /> � Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: co-9-A9 <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: AG.eD Filter Pack From: To: <br /> Geologist: F_.Ia6 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: COWLETION c�tznoN <br /> Method: Ground Surface <br /> Screening Method: cry <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> n. <br /> SPOILS _ .. <br /> Contamination Noted: ❑ Yes El No =` <br /> If yes, spoils storage Location: slatted <br /> soon — 2 <br /> Covered: ❑ Yes ❑No = vsA pack <br /> If yes, material: <br /> _x <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tio' n• n' <br /> Grout Material: <br /> Gallons of Grout Used: 7 ,� $64110,s Casing <br /> '' Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Sorin Installation Slot Size: <br /> g Coring 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 16Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest uBags 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 a 40 80 s <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 />