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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> "A Of' Greatness grows L. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: if Z Inspector: uidi>r+^ CONSTRUCTION <br /> Facility Address: 2-45/ <br /> Well Address: Total Depth: obi <br /> WP# Well#: w-/ Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: <br /> Min 2"Annular EHD Seal Verified: M Yes ❑No <br /> ��S/� e i <br /> Driller Onsite: ?/G„y✓�' Screen Length From: To: 7�7 <br /> Consultant: � Filter Pack From:. To: 7� <br /> Geologist: t pt/ Bentonite From: 74 To:-6-4� <br /> Grout From: 61F To: 2 <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: height T: <br /> SAMPLING ABOVE-GROUND T <br /> COhS'LEnON CNRISTY-BOX <br /> Holding Temperature: COMPLETION <br /> Method: Ground vtao• '-:F7 --- <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt• <br /> n. <br /> SPOILS —# = <br /> ky9 = a <br /> Contamination Noted: El Yes ❑No <br /> t = n <br /> If yes,spoils storage Location: •lonad 4 _ <br /> o <br /> N = B <br /> Covered: El Yes ❑ •notion <br /> No — 9'w+P,44 <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: R• _ #• <br /> Grout Material: Ae er <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: pt/a SL/i NO <br /> Well Installation ❑Well Destruction Blank 75�'' Feet Screen S Feet <br /> ❑Boring Installation ❑ Slot Size:�oBoring Destruction gags of Cement: LL <br /> METHOD USED Bags Sand/Gravel: j* '- 6gfS <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: G40-7W <br /> Filter Pack Type/Size: W3 <br /> ❑ Gravity XTremie ❑Other: Type of Method: ptl� <br /> Water Cement 471b water Cement 941b <br /> stations Bags aallons Bairs <br /> Thickest Thinnest aBags Thickest thinnest wags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 s s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 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 /> a/ ha's a 2& 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />