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SAN.,JOAQUIN Environmental Health Department <br /> ! al' : —COUNTY— <br /> °ac, '+ Greotness grows here. <br /> 5-X bliMonitoring Well/Soil Boring Inspection Report <br /> Date: Inspector.. . Oat-/-) CONSTRUCTION dje_ VIA-� <br /> FacilityAddress: ' nA' ' i� 1 <br /> Well Add r ss: Total Depth: C� r Lis <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: I V 5 Min 2" Annular EHD Seal Verified: ❑ Yes EJ No <br /> Drilling Company: c <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: �,rp 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 ABOVE-GROUND <br /> Holding Temperature: COMPLETION CCOMPLEMON <br /> Method: Ground Sudacs <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes El No —`--tt' <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: alonad <br /> section <br /> Covered: ❑ Yes ❑No y _ Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: qi/ iI t" tt tt <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring InstallationoBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ;44ravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 11 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 35 7 35 70 7 <br /> 40 8 40 80 8 <br /> l 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />