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• SAN ,J O A Q U I N Environmental Health Department <br /> COUNTY <br /> Greatness grows here. 1% <br /> Monitoring Well/Soil Boring Inspection Report , I <br /> Date: ' I3 /a Ins ector: rAII'ssii X1''� CONSTRUCTION <br /> Facility Address: �:�� <br /> Well Address: Total Depth: qj <br /> WP# Well#: Drilling Rig Type: Aj <br /> Soil Boring#: <br /> Drilling Company: r t jS Q� �^ Min 2" Annular EHD Seal Verified: ❑ Yes L1 No <br /> Driller Onsite: CScreen Length From: To: <br /> Consultant: Orm%f 0 Y Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes �kNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes NNo casing <br /> If yes, location and distance: IFILT height <br /> SA LING ABOVE-GROUND <br /> Holding mperature: �t`� 1ON COMPLETION <br /> Method: G=nd Surf ac* <br /> Screening Metho cr«n <br /> Verified Chain of Custo El Yes El No �tt' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes 11 No <br /> C <br /> If yes, spoils storage Location: atottod = . <br /> s�rion — 8 <br /> Covered: El Yes El No _ g w+P-* <br /> If yes, material: 4: <br /> 1Z-L& <br /> Q/ <br /> �� ,, .. <br /> GROUTING or DESTRUCTION Total Depth: � �W <br /> Depth to Water: "`��U tt• tt• <br /> Grout Material: f\ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> a-1 f f - 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 />