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SA N J OAQ U I N Environmental Health Department <br /> - COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: S/30/Z4 Inspector: V]•L* CONSTRUCTION <br /> Facility Address: SSS ljtH 4 V- <br /> Well Address: Total Depth: <br /> WP# ?.ymQ? lm'L Well#: Drilling Rig Type: <br /> Soil Boring#: CP�V.C40V 1-7. Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: (-.e beftj,W7 <br /> Driller Onsite: 7ca' p Screen Length From: To: <br /> Consultant: (sCGSH'1�c-c <br /> Filter Pack From: To: <br /> Geologist: VIClti t <br /> 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 /> SAMPLING A180VE-GROUND <br /> Holding Temperature: COWLET1ON COMPF CN <br /> Method: Grcund Sumacs <br /> Screening Method: arm+ <br /> Verified Chain of Custody: ❑ Yes []No �ft' <br /> ft. <br /> ft. <br /> SPOILS = <br /> — a <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> sacton <br /> Covered: ❑ Yes ❑No = prswi F <br /> ack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: %4ec4d C{+wi e,i►L <br /> Gallons of Grout Used: rJ �.5 [w ot MATERIALS DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation *oring 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 _ 1 remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall Bags Rallons Bags <br /> Thickest Thinnest bBags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mlx 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 8 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 />