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SANJOAQUIN Environmet..al Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7-'f-t9 Inspector: AfttO` CONSTRUCTION <br /> Facility Address: Z3d ZZ144W 04- <br /> Well Address: Total Depth: <br /> WP# 00 a ?Pffy I Well#: Drilling Rig Type: <br /> Soil Boring#: /!/P/09 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: 6,iaeeto& Screen Length From: To: <br /> Driller Onsite: DK d <br /> /�y' r �I �.b�^' Filter Pack From: To: <br /> Consultant: <br /> Geologist: TCw Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes,location and distance: height <br /> eL <br /> SAMPLING ABOVE-GROUND ciwlsrreox <br /> Holding Temperature: GOAFLEnON COMPt.EnoN <br /> Ground st'tao. <br /> Method: <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑Yes ❑ oN �--n, <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No ` __ s <br /> If yes,spoils storage Location: ala Led K- <br /> w on e _ <br /> Covered: ❑Yes ❑No = pr,va paa <br /> If yes, material: <br /> f - — <br /> GROUTING or DESTRUCTION Total Depth: A—,, <br /> '�� — . <br /> Depth to Water: Z7 <br /> Grout Material: Nam efwltw MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: /0 51!� Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> []Boring Installation 40ring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity R(Tremie []Other: Type of Method: <br /> Water Cement 471b Water cement 941b <br /> R.5 <br /> ns Bags allans Bags _ <br /> ThickestThinnest Bags Thickest Thinnest #Bags _ BentonitelCement Mix 3%MIX 5°/a MIX <br /> s 1 s 10 1 _Bentonite per 47 lb 1.4112A7 _ <br /> 10 2 10 20 2 Bentonite er 94lb 2.82 4.7 _ <br /> 15 3 15 30 3 -20 4 20 40 4 <br /> 25 5 25 so 5 <br /> 30 6 30 60 6 <br /> 3s 73540 1 8 40 80 B <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.sFcehd.com <br />