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SAN�JOA UIN <br /> Q environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: &AeAwa, CONSTRUCTION <br /> Facility Address: W•�amolhr��sF /kF <br /> Well Address: Total Depth: <br /> WP# a0 Well#:O ;-2- 'f Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 62dcc.� Jerk <br /> S/y/ Screen Length From: To: <br /> Driller Onsite: <br /> Filter Pack From: <br /> Consultant: �I ncdds �s�e,..tceoj To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO caging <br /> If yes,location and distance: height <br /> GG <br /> SAMPLING ABOVEGROUND CHRIM-BOX <br /> Holding Temperature: ool.,F'LETION COMPLEn.ON <br /> Method: Ground s rlacv <br /> Screening Method: arcut <br /> Verified Chain of Custody: ❑ Yes ❑Nott' <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No ° <br /> If yes,spoils storage Location: s1o"d t:j = � B <br /> so<ton sl = <br /> Covered: ❑Yes ONO — grasaPack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: 3 Z l„e/ 1ST t/.)'{l <br /> � tt. <br /> Depth to Water: <br /> Grout Material: al�tewe ti 2- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 48A, 2'f vmwt, $Ff •o <br /> Casing Type: <br /> ❑Well Installation 53OWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> L$Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Ba s eallons Bags _ <br /> R <br /> Thinnest #Bags Thickest Thinnest #Bags _ Bentonite/Cement Mix 3%Mix 5% Mix <br /> 5 1 5 10 1 Bentonite per47lb 1.41 2.4710 2 l0 20 2 Btlte er 941b 2.82 4.715 3 15 30 320 4 20 40 4 <br /> 25 5 25 50 5 <br /> 30 6 30 60 6 <br /> 35 7 35 70 40 g 40 g0 g <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 />