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SAN-JOAQUIN Environmental Health Department <br />--COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />11 <br />Date: �21� Inspector: �. V*l CONSTRUCTION <br />Facility Address: 510 tNy-c <br />Well Address: Total Depth: 7-0' <br />WP# baa -1105 Well#: Drilling Rig Type: cl VX n� <br />Soil Boring#: $ fd <br />Drilling Company: V k H1 Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />�r'� ��; K� <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes AN o COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes )-No casing <br />If yes, location and distance: WT <br />height <br />SAMPLING nsoyE•GAouNo _ <br />Holding Temperature: COMPLEMN CCCMPLEnCN <br />Method: Ground Surf acs <br />Screening Method: grout <br />Verified Chain of Custody: ❑ Yes El No �tt' <br />tt. <br />tt. <br />SPOILS <br />= a <br />Contamination Noted: ❑ Yes ❑No = <br />If yes, spoils storage Location: stottaa <br />.on — B <br />Covered: ❑ Yes ❑ No` _ gravel <br />Pack <br />If yes, material:. <br />�x <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water No waw tt• tt' <br />Grout Material: <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br />❑Boring InstaIlationXBoring Destruction Slot Size: <br />Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />Qressure Grout ❑Over Drill Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />❑ Gravity ❑Tremie ❑Other: Type of Method: <br />Water <br />alIII ons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <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.sacehd.com <br />