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SAN' JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greatness grows herr. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �, Inspector: CONSTRUCTION <br /> Facility Address: Avs4_,r M-1 <br /> Well Address: Total Depth: <br /> WP# p 3 a ell#: Drilling Rig Type: <br /> Soil Boring#: 1""�2 Min 2" Annular EHD Seal Verified: ❑ Yes L1 No <br /> Drilling Company: 'rctb-r <br /> Screen Length From: To: <br /> Driller Onsite: C�A <br /> Consultant: TbVAZ-Ki or._ 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 ABOVE-GIRCUND <br /> Holding Temperature: COWLETION c�tFnoN <br /> Method: Ground Surtaics <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> n. <br /> h. <br /> SPOILS a <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes, spoils storage Location: slotted <br /> &*Con <br /> Covered: ❑ Yes El No _ g-vWpack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> n. <br /> Grout Material: E MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation EXBoring Destruction gags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> [ Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> water Water Cement 94 lb <br /> all Basgallons Bags <br /> Thickest Thinnest Thickest Thinnest 11 Bags Bentonite/Cement Mix 3% Mix 3% 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 0, <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 Nl 4-y.3 to D Ltk-- (4 <br /> 20 1 40 a 40 e0 e O <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.smcehd.com <br />