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SAN. JOAQUIN <br />COUNTY <br />�9i�JP Greatness grows here. <br />Environmental Health Department <br />0/ <br />Monitoring Well/Soil Boring Inspection Report <br />Date:A 1 Inspector: �' v CONSTRUCTION <br />Facility Address: tzo 4' <br />Well Address; Total Depth: � <br />WP# �► Well#: Drilling Rig Type: �- <br />Soil Boring#: <br />GL <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: <br />Driller Onsite: U Ka A Screen Length From: To: <br />Consultant: cl114 r Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />SAMPLING ABovE-GROUND <br />Holding Temperature: c V11-t��COWILF ON CoEncN <br />12Method: }jV +�S.S -a- `e S ,�)j I c3r�,ndsur+a<. <br />Screening Method: �L f eu grout <br />Verified Chain of Custody: El Yes El No �it. <br />X10-'' n. <br />i tt. <br />SPOILS CV1�ht <br />V'v <br />ace <br />1 <br />Contamination Noted: ❑Yes ❑No — e <br />If yes, spoils storage Location: Waned Z. <br />sac70n — <br />Covered: ❑ Yes ❑ No <br />If yes, material:_: <br />GROUTING or DESTRUCTION Ttai Dept <br />Depth to Water: fI <br />Grout Material: Cc C MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />El Boring Installationoring Destruction <br />METHOD USED <br />❑ .,/Pressure Grout ❑Over Drill <br />"�CzCavity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />2.5 5 <br />Bags <br />1 <br />Thickest Thinnest <br />uBags <br />5 10 <br />1 <br />5 <br />10 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <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.secehd.com <br />