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SAN ,JOAQUIN Environmental Health Department <br /> U —COUNTY---- <br /> Greotness grows herr:. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �� O� Inspector: e4_kre'd CONSTRUCTION <br /> Facility Addre s: 129;BeL l'�� <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Prk-7 <br /> Drilling Company: /IiI,G� �,i, Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: r[1lbY 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 caging <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLEfION CoMPPLET oN <br /> Method: GrowndSurface T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> h. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: stottnd <br /> s�c4on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 8�+ <br /> Depth to Water: ft. F — n <br /> Grout Material: at C&ML vitMATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <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 /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest ttBags 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 /> 20 4 20 40 4 <br /> 1205 25 5 25 50 5 1"✓ 2, ��� ) �� 1�� V� - " <br /> 15 30 6 30 60 6 I <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 V ri�' ( IA „ n ��/1 I(� -jr <br /> JJ 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />