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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> „ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> � 2 Date: Z ector: . & kr%(A, CONSTRUCTION <br /> Facility Address: ins <br /> Well Address: Total Depth: <br /> WP# Vk70UVZ6 Well#: Drilling Rig Type: <br /> Soil Boring#: C\.SP �% <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> �C��o�n�p1�y2YT(.2 <br /> Driller Onsite: rT9 r CU 1r Screen Length From: To: <br /> Consultant: 61(..L ><^V t irdrtwa�� <br /> Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: � height T. <br /> SAMPLING A80VE-61FIDUND T <br /> CONFLEnON COMPLE-BO <br /> Holding Temperature: cornat.EnoN <br /> Method: °roan°Surlac9 T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �n• <br /> —.n. n. <br /> SPOILS <br /> y O <br /> Contamination Noted: ❑ Yes ❑No Y4 c <br /> If yes,spoils storage Location: <br /> .wtue , o <br /> #YC10n <br /> Covered: ❑ Yes ❑No = w-Mlack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ _ I VOW <br /> Depth to Water: TM• — n <br /> Grout Material: Wea <br /> Gallons of Grout Used: (jQWQJt� MATERIALS/DEVELOPMENT <br /> (?�1r1a 6�OSrT� <br /> Casing Type: <br /> ❑Well Installation I&Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> LPressure Grout Cover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water ment 47lb Water Cement 94lb <br /> atlans GaRs eallons Bags <br /> Thickest Thinnest gs Thickest Thinnest #Bags BeotonitelGement MIx 3%MIX 5%MIX <br /> 2.5 s 1 5 10 1 Bentonite or 47 lb 1 1.41 2.47 <br /> s 10 1 2 10 20 2 Bentonite per 94 lb 1 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 40 80 1 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.s'cehd.com <br />