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• f/PpUlly C'� <br /> SAN JOAQUIN Environmental Health Department <br /> 4 COUNTY— <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Atl6 1 ZA Inspector: CONSTRUCTION <br /> Facility Address:Sol W• te.✓ltuuv+10J, cr <br /> Well Address: V — Total Depth: <br /> WP# 1Z Ou l 01 Well#: Drilling Rig Type: <br /> Soil Boring#: p- l — Ll Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: L GC .'Oe c <br /> Screen Length From: To: <br /> Driller Onsite: U <br /> �OSc. <br /> ��� ��Sta��a✓�� Filter Pack From: To: <br /> Consultant: <br /> Geologist: �ct���� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> _ <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO&PLETION cOMP=CN <br /> Method: Ground Suiacs <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No �ft• <br /> tt. <br /> ft. <br /> SPOILS : <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: Slotted <br /> on — B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: R. <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: I i.ZS 1 n• n' <br /> Grout Material: �Ars , Gev✓I M4 <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ��. S �,u� Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Moring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity Rafremie ❑Other: Type of Method: <br /> 1 <br /> Water Cement 471b Water Cement 941b <br /> gallons Bags gallons Bags <br /> Thickest Thinnest ABags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 90 9 <br /> S V , t.cs�C-I 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 />