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A`��x SANoJOAQUIN <br /> _ Environmental Health Department <br /> COUNTY-Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:0Z/Z9/Z4 Inspector: .beg CONSTRUCTION <br /> Facility Address: 23G1 olti /r,til A rloeh <br /> Well Address: Total Depth: <br /> WP#Q3Li5Z1f+604511'* Well#:SV Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: CC6CCW4& &1L'fW 4WIMlcsI 0n"u Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onslte: P391A I d ,TO Se �✓ Screen Length From: To: <br /> Consultant: 16lesil c� All nXII, Lrt o Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: C Yes ❑No COMPLETION El Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No <br /> If yes,location and distance: height <br /> SAMPLINGv �Ao ceiRisrYBox <br /> Holding Temperature: cot�i nosy � ox <br /> Method: Gtolinascracs�fi^'" ^�^ <br /> Screening Method: aroot <br /> Verified Chain of Custody: ❑Yes ❑Noft. <br /> ft. j <br /> SPOILS �ft. <br /> Contamination Noted: ❑Yes jNo ^ ` <br /> If yes,spoils storage Location: ab to f M l <br /> S*cl n <br /> Covered: El ❑No <br /> If yes, material: <br /> GROUTING-or-DESTRUCTION•Total Depth:-$!- !2 . <br /> Depth to Water: in/ —it ft. <br /> Grout Material:_hP—cli} Getwtetil MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used; 2�.5 <br /> Casing Type: <br /> ❑Well Installation S Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring installation CBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> rP ressure Grout COver Drill Type/Brand ofBentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity CTremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement94t <br /> allons Boo gallons BeRs <br /> Thickest Thinnest Waags Thickest Thinnest OBags 13entanitelComent Mix -3%Mix 5a/a MIX <br /> ti 5 1 5 16 1 eentoniteper471b 1.411 2.47 <br /> 10 2 10 20 a feentonite per 94lb 2.821 4.7 <br /> 7.5 15 8 15 8o 8 , <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 ao 6 3o 60 6 <br /> 17,5 85 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> welt : SVlot, 10y,ltolil111141116, 11�1It21123, Ig1113L 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95206 I T 209 468-34201 F 209 464-0138.1 MM.slcehd.com <br /> I <br />