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S A N J O A Q U I N Environmental Health Department <br /> i , -COUNTY— <br /> tsir_cih�esa gro,�s I ;_r� . <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: II 21 Inspector: al 'na3 CONSTRUCTION <br /> Facility Address: 1b�r3a Hou�tanc� 2 LcLfig1op <br /> Well Address: Total Depth: <br /> WP# 2uoU2c T Well#: Drilling Rig Type: aD1100! S+eyt PAMeK <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: '., es ❑No <br /> rtQq � -ji Driller Onsite: Screen Length From:. To: Z.y Consultant: _ A IrGG+�,S <br /> Filter Pack From:. To: 2.3. 5 t <br /> Geologist: I��iC�tifl Bentonite From:�,5 % To: � . � � <br /> Grout From: H, 5 t To: 0(-r`a,Q4-• <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND CHRLSTY_ <br /> Holding Temperature: COWPLETION COMPLETION <br /> Method: GroundSurfa" `—+----- <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = m <br /> If yes, spoils storage Location: <br /> y• S �rov+ <br /> slonad = <br /> soon — <br /> Covered: ❑ Yes ❑No = 72Vw I <br /> aCK <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: __ <br /> Depth to Water: °I" lot a: <br /> Grout Material: Qeay &e mar4. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 5aa Casing Type: <br /> ?<*ell Installation ❑Well Destruction Blank $1 Feet Screen �� Feet <br /> ❑ Slot Size: 6 . O k (�Boring Installation ❑Boring Destruction Bags of Cement: 314 <br /> METHOD USED Bags Sand/Gravel: t 0 <br /> ❑Pressure Grout ❑Over Drill 3�� � ' Type/Brand of Bentonite: pf�'��-t� �1 f y <br /> Filter Pack Type/Size: _ 2., t 2 <br /> Gravity �Tremie ❑Other: Type of Method: r&g'T" u- <br /> Water ement 471b Water Cement 941b <br /> gall Bags jaallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 i Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 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 />