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SANJOAQUIN Environmental Health Department <br /> 12�I —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: std CONSTRUCTION <br /> Facility Address: 5 3/oS �7rcG� <br /> Well Address: Total Depth: <br /> WP# eb 3;6757Well#: Drilling Rig Type: <br /> Soil Boring#: ;� 2, 3. Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <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 El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ASOVE•GROUND <br /> Holding Temperature: COMPLETION cc _w EneN <br /> Method: G=nd Surface <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> tt. <br /> ft. <br /> SPOILS w <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes,spoils storage Location: ab�e <br /> sacdcn "— <br /> Covered: ❑ Yes El No = srzv+Pack <br /> If yes, material: t< <br /> r <br /> GROUTING or DESTRUCTION Total Depth: Zz3 y X26 <br /> Depth to Water: i(b��) t3S�j �• n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation XBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie XOther:/""5e)Q,,/( Type of Method: <br /> Water Cement 47lb water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest J1 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 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> "&_^ to� 10/16/2017 <br /> A/ZO <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />