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SAN 10AQUIN Environmental Health Department <br /> --COUNTY- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 51t5/21- Inspector: 6.61kirpt CONSTRUCTION <br /> Premise Address: Qg99 1. Aunrlm 'Ro., M&_mnca <br /> WP#: WT,2L011 7!J Total Depth: <br /> Well#: — Drilling Rig Type: <br /> Soil Boring#:pT- 1, 'DPT-.% + a-P'r-S Min 2"Annular Sea Verified: ❑ Yes ONO <br /> Drilling Company: ?emmCQ..E Screen Length Fr m: To: <br /> Driller Onsite: S0nE Ammytz Filter Pack Fr m: To: <br /> Consultant: CTnoay�j-e.c. <br /> Geologist: E T,.%AN L�YL+GE� Bentonite Fr m: To: <br /> Grout Fr m: To: <br /> Public Water System Onsite: ❑Yes ONO COMPLETION Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No asirg <br /> If yes, location and distance: eight <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: GONFLEDON Ccompt.EnoN <br /> Method: + <br /> Screening Method: ot«n <br /> Verified Chain of Custody: ❑ Yes ONO �tt' <br /> t <br /> it. t. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No — <br /> r <br /> If yes, spoils storage Location: slotsrd ;' <br /> section !6 — <br /> Covered: ❑ Yes ❑No -Rvw Pack <br /> - - <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: HO FT. <br /> Depth to Water: — n• n' <br /> Grout Material:?cmrL&,ga CEMENT ►Ype 11 MATERIALS DEVE OPMENT <br /> Gallons of Grout Used:57.A c .,. Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank tt Screen Feet <br /> ❑Boring Installation I$B Slot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Be tonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Si e: <br /> ❑ Gravity ®Tremse ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 541b <br /> allons Bags Zallons Bags <br /> Thid;est Thinnest 11Bags Thickest Thinnest 4Bags <br /> 2.5 5 1 5 10 1 Bentonite) ement Mix 3% Mix 5% Mix <br /> 5 10 2 10 20 2 Bentonite p r 47 lb 1.41 2.47 <br /> 7.5 15 3 1 15 30 3 <br /> 10 20 4 20 40 4 Bentonite p r 94 lb 2.82 4.7 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 B <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />