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QUIN SAN%jOA <br /> Environmental Health Department <br /> —COUNTY- <br /> 4_ --# <br /> Greatness groves here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: q. 4 Inspector:� Y11�YlaUl3) CONSTRUCTION <br /> Facility Address: 10�t➢ f-11p7, lb live l tCl,� <br /> Well Address: Total Depth: <br /> WP# 24006)cIL1 Well#: M— W-2,11 Drilling Rig Type: <br /> Soil Boring#: TTZ;' F CVP— 1 2 S V P-2 Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: yqjw ywi�YN pl <br /> Driller Onsite: T- ) Screen Length From: To: <br /> Consultant: d012 f lf?{1n Filter Pack From: To: <br /> Geologist: ftin Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes III No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes, location and distance: f height <br /> R <br /> SAMPLING ABOVE-GROUND <br /> t:ONFLfiTION COMPLYAO <br /> Holding Temperature: COMPLETION <br /> Method: Gmnd Solace <br /> Screening Method: ar" <br /> Verified Chain of Custody: ❑ Yes END ft. <br /> ft. <br /> SPOILS <br /> e <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes,spoils storage Location: ' <br /> slatted 1 = B <br /> Covered: ❑ Yes ONO section — 9-VW Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 10tt IX Z = 1 <br /> Depth to Water: 1 rn�,,, ft• ft• <br /> Grout Material: ' aG tA^ leyX MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: -W(Ali QWS (0, 1 <br /> Ip.G� II�hS Casing Type: <br /> ❑Well Installation `�yVell Destruction VV �t o Blank Feet Screen Feet <br /> El Boring Installation\RBoring Desu trction In,(rvvt Slot Size: <br /> — 331 0017M Bags of Cement: <br /> METHOD USED ytZovl- Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ,Gravity /xTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94Ib <br /> allons Bags vallons Batts _ <br /> Thickest Thinnest NBags Thickest Thinnest 9Bags _ Bentonite/Cement Mix 3%MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 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 I7 <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.s*cehd.com <br />