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S A N J O AQ U I N Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Ins ector: AA -^ CONSTRUCTION <br /> Facility Address: � •�+`��t J2c <br /> Well Address: Total Depth: <br /> WP# 24erd3 Well#: A MWJ -Z Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: -e- <br /> Driller Onsite: c ��=��c-� Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: O_K__Z <br /> Geologist: `Gi Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> .f6 <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLETION COMPLEPION <br /> Method: Ground Surface <br /> Screening Method: K111 grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No — m <br /> If yes, spoils storage Location: stott�d -= <br /> aecton = <br /> Covered: ❑ Yes ❑No - t <br /> If yes, material: <br /> rt� — <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: /� tt. n• <br /> Grout Material: <br /> Gallons of Grout Used: 1� el Ca MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> kressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons -Bags allons Bags <br /> Thickest Thinnest 3tBags 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 Ib 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 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />