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SANJOAQUIN <br /> Environmental Health Department <br /> —COUNTY— p <br /> `r9r_rFcaN=� <br /> Greotness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �/' JS Inspector: CONSTRUCTION �— <br /> Facility Address: SIL �/I e' / <br /> Well Address: CLIA Total Depth: ✓-e^4 + C'hI'oS <br /> WP# Well#: 44/, Drilling Rig Type: �K <br /> Soil Boring#: I Min 2" Annular EHD Seal Verified: ❑ Yes <br /> Drilling Company: -, r r— p/72 <br /> Screen Length From: To: <br /> Driller Onsite: <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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION COOMPLETION <br /> Method: Ground Surface <br /> Screening Method: �.A �_n <br /> Verified Chain of Custody: ❑ Yes El No ?✓, tt <br /> SPOILS --f—n. _ <br /> Contamination Noted: ❑ Yes ❑No f <br /> If yes,spoils storage Location: <br /> 60n <br /> Covered: ElYes El No <br /> VVI <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> AZ' <br /> Depth to Water: aV' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity Premie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest 9Bags Bentonite/Gement Mix 3% Mix 5%Mix <br /> 2.5 5 1 s 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 /> +0 v W�¢ � wk�� {!4r <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.secehd.com <br />