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SAN,JOAQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: y-vqC-y3 Inspector: CONSTRUCTION <br /> Facility Address: Iftd- ty ad <br /> Well Address: Total Depth: <br /> WP#An4"V ,SCE Well#: Drilling Rig Type: <br /> Soil Boring#: ^3Y, Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: �✓�',�j <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: a 45 — 4ee"- Filter Pack From: To: <br /> Geologist: [wiGl �, ,� � / /�rQ Bentonite From: To: <br /> 1(e� yti�S Grout From: To: <br /> Public Water System Onsite: El Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No - r casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Ct4i M-Box <br /> COMPLETION <br /> Holding Temperature: O�Y' COMPLEf110N <br /> Method: --Tr—�orwadSurlacv "T <br /> Screening Method: If!'3yX: « grout <br /> Verified Chain of Custody: ❑ Yes []No <br /> n. <br /> SPOILS <br /> L e <br /> Contamination Noted: El Yes ❑No ti —_ <br /> If yes,spoils storage Location: <br /> = B <br /> aacCon 1•I = <br /> Covered: ❑ Yes ❑No <br /> If yes,material: <br /> t <br /> GROUTING or DESTRUCTION Total Depth: 1(0, 16 = .. <br /> Depth to Water: /UD aq_? Y n. L 1. = tt. <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Y b �cgglO.�S Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> g Loring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> f� Gravity Itrremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement341b <br /> allons Bags stations Baas <br /> Thickest Thinnest kBags Thickest Thinnest Mits Bentonite/Cennent Mix 3% MIX 5a/o MIX <br /> 2.5 5 1 s 10 1 Bentonite per 47lb 1 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 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 3o 6 30 60 6 <br /> 17.5 35 7 35 70 1 7 <br /> 20 40 1 40 80 8 <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 />