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SAN_JOAQUIN Environmental Health Department <br /> (" --COUNTY— <br /> • Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 0""5' totd Inspector: A&td^ CONSTRUCTION <br /> Facility Address: 3S� ' Total Depth: 70r <br /> Well Address: C qS <br /> WP# aoHIOti Well#: Alld" Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ElYes ONO <br /> Drilling Company: C*S e Screen Length From: '70 To: 601 <br /> Driller Onsite: XXISA Filter Pack From: 70` To: 5 !` <br /> Consultant:_�'f Bentonite From: Yff To: a6 <br /> Geologist: E lG Grout From:yle-- To: s✓rFce <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe C]hristie Box <br /> Domestic Well Onsite: ❑Yes ONO cae Ling <br /> height . <br /> If yes,location and distance: jx_ _ <br /> SAMPLING ABOVEGROUND q{RIM-BOX <br /> COMPLETION COMPLETION <br /> Holding Temperature: Groum surfs <br /> Method: grout <br /> Screening Method: <br /> n. <br /> Verified Chain of Custody: ❑ Yes ONO n• <br /> SPOILS r >3 <br /> Contamination Noted: <br /> ❑Yes ONO <br /> If yes,spoils storage Location, ae 8 <br /> �acgon ?� c <br /> Covered: ❑Yes ONO txa�t� <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: • n. F = n. <br /> Depth to Water: `1'Q <br /> Grout Material: n/ra•oo�ea8r+4 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �✓G �lcti 4d <br /> Casing Type: � <br /> H3Mell Installation ❑Well Destruction <br /> Blank 3a Feet Screen zer Feet <br /> Slot Size: •ola <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: -- <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: <br /> ❑ Gravity fi7Tremie ❑Other: <br /> Type of Method: P/`'` <br /> Water Cement 471b Water Cement 94111 <br /> allons Ba s allons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest 4aap _ Bentonitel.ement Mix 3%Mix 5%Mix <br /> 1 Bentonite per 47 Ib 1.41 2.47 <br /> 2 _ <br /> I s 10 2.82 4.7 <br /> 5 10 2 10 20 2 Bentonite per 941b <br /> 7.5 IS 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 5o 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 411 1 B 40 so s 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 />