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A <br /> .0<<ou,ti SAN JOAQUIN <br /> -.f Environmental Health Department <br /> ►.:.'>1 _' 1 COU NTY---- <br /> �q�;FG:,; Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z Insp ctor: � CONSTRUCTION <br /> Facility Address: .9X;0s• <br /> Well Address: Total Depth: y <br /> WP#(10 'ItSd$q Well#: MLV-1 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: � �K Min 2" Annular EHD Seal Verified: Yes ❑No <br /> Driller Onsite: �Y ke Screen Length From:_,�� To: 30! <br /> Consultant: 135t Filter Pack Fro m:�f To: Z <br /> Geologist: "aµ Bentonite From: 7 To: Z'.; <br /> Grout From: Z 3 ' To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe XChristie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> 31T— <br /> SAMPLING Agpyg.GROUND <br /> Holding Temperature: COMPLETION COMP�LEMN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No 4 ft' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slon2d y; .- <br /> aac�on — <br /> Covered: ❑ Yes ❑No vz > <br /> acx <br /> If yes, material: =' _ <br /> GRnth,,,. Thor DESTRUCTION Total Depth: <br /> Depth to Water: n• tt' <br /> Grout Material: c <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: J <br /> Casing Type: Ivy, _ ttC7 <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: +D 10 <br /> oring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: yf2 <br /> ❑ Gravity D(Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags Rallons Bags <br /> Thickest Thinnest #Bags 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 1 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 80 8 <br /> 10/16/2017 <br /> Imo`` <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />