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SAN JOAQUIN <br /> Environmental Health Department <br /> jj"i __ —COUNTY . <br /> Greotness grows here <br /> 7 Q Monitoring Well/Soil Boring Inspection Report <br /> Date: J 2� I Inspector: U�K r CONSTRUCTION <br /> Facility Addres : 0 <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: *( <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Fes'A Filter Pack From: To: <br /> Geologist: vJ b%)-, 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 CCOMPLET oN <br /> Method: Ground Surface <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No �n- <br /> n. <br /> SPOILS = <br /> — - e <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: <br /> stoned <br /> aeon —' 3 <br /> Covered: ❑ Yes ❑No = gravol s <br /> ack <br /> If yes, material: n <br /> GROUTING or DES RUCTION Total Depth: / bT� . <br /> Depth to Water: I t n• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation)�' Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity �Tremie ❑Other: Type of Method: <br /> Water //Cement 471b Water Cement 94 lb <br /> allons Bas gallons Ba <br /> Thickest Thinnest uBags Thickest Thinnest 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 <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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sucehd.com <br />