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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> DateA.2JLI.2lD2'-1 Inspector: C.Th&1r'lil'I TG{ CONSTRUCTION <br /> Facility Address: INM S• D1arnaniASti.f110 <br /> Well Address: Total Depth: <br /> WP#ZWON't1i Well#: 'N -ID Drilling Rig Type: <br /> Soil Boring#: � ,4 Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: UaSfa0if'i <br /> DrillerOnsite: s)IALI.n $ r )(1SPi Screen Length From: To: <br /> Consultant: RTG CzYOUp &IZV1t,cl f t-10i 1¢chtilMA Filter Pack From: To: <br /> Geologist:�(ll(lYl 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: R height <br /> SAMPLING ABOVEGROUND CHRI5TY-BOX <br /> Holding Temperature: cowLEnoN COMPLETION <br /> Method: Groom s <br /> Screening Method: ara+t <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> e. <br /> SPOILS y <br /> Contamination Noted: ❑ Yes ❑No y� — <br /> If yes,spoils storage Location: <br /> alott — 8 <br /> tacdon � — <br /> Covered: ❑ Yes ❑Nopack <br /> If yes,material: 1� <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used:(1 f MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation)SBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ATremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement94lb <br /> allons Bags gallons Baits <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 16M MIX <br /> 2.5 5 1 5 10 1 Bentonile per47lb 1 1.411 2.47 <br /> s 10 2 10 20 2 1 Bentonite per 94 lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> Us 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 1 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 />