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SANJOA UIN <br /> Q Environmental Health Department <br /> (° 1_ij `� —COUNTY— <br /> 'S'<gr�pt..) ' Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: //3 23 InspecAtor:� CONSTRUCTION <br /> Facility Address:P2a��'4 <br /> Well Address: Total Depth: <br /> WP# w *?,97 Well#: E!s'A-)61{o�T7 Drilling Rig Type: <br /> Soil Boring#: /9/1 ZV Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company:TP V <br /> Driller Onsite: ,S'!*frb 21O, Screen Length From: To: <br /> Consultant: / iri Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> QL 6/ZA Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No—l- COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> Co&FLETION CRISTY- O <br /> Holding Temperature: COMPLETION <br /> Method: earndsuiacs 7_ <br /> Screening Method: armd <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> _n. <br /> n. <br /> SPOILS <br /> Y' = <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: 4wnoa ' _ s <br /> section = S <br /> Covered: ❑ Yes ❑No � pack <br /> If yes, material:GROUTING or DESTRUCTION Total Depth:��� � Q�Depth to Water: L ., <br /> — tt• <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �7 S9/�" ''55�{� z'-_C <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity i Tremie Xother: S Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags 2allons Basis <br /> Thickest Thinnest NBags Thickest Thinnest pBaBs BentonitelCement MIX 3% MIX 5%Mile <br /> 2.5 5 1 5 10 1 Bentonite er47lb 1.41 2.4.7 <br /> i 2 10 20 : <br /> 7.5 1s 3 15 30 3 Bentonite per 04lb 1 2.821 4.7 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 1s 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 I T 209 468-3420 1 F 209 464-0138 I www.s'cehd.com <br />