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u <br /> SAN J OAQ U I N Environmental Health Department <br /> �}lli`, COU NTY— <br /> `c �P� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Y / Inspector: CONSTRUCTION <br /> Facility Address: c-P.r <br /> Well Address: Total Depth: <br /> WP# CX' -5 Well#: Drilling Rig Type: <br /> Soil Boring#: e p r /, c p rZ <br /> Min 2"Annular EHD Seal Verified: El Yes 11 No <br /> Drilling Company: r C e" <br /> Screen Length From: To: <br /> Driller Onsite:T � Filter Pack From: To: <br /> Consultant: <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 A80VE-GROUND <br /> CHRHolding Temperature: CONVLETION COMP�_LEMN <br /> Method: Ground Surlacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes E]No �tt. <br /> tt. <br /> tt. <br /> SPOILS K <br /> aY = a <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: Started _ B <br /> sac�on <br /> Covered: ❑ Yes ❑No = g, <br /> v*1 pack <br /> If yes, material: ax <br /> x — <br /> GROUTING or DESTRUCTION Total Depth: S�''j <br /> Depth to Water: -7 ' <br /> Grout Material:A,Gb Ft c..ee <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation kBoring Destruction 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 ❑Tremie ❑Other: Type of Method: <br /> ater ,pfent 47 Water Cement 94 lb <br /> allon1, Bas _ gallons <br /> Ba s <br /> Thickest Thinnest 4Bags Thickest Thinnest 4Bags 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 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 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />