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SAN JOAQUIN Environmental Health Department <br /> —COUNTY- <br /> „�;,. Greotness grows serf <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 [! Inspector:'01"" /1 CONSTRUCTION <br /> Facility Address: 301 C0 :5,:p=r <br /> Well Address: Total Depth: <br /> WP# 60-a,97 15(� Well#: Drilling Rig Type: <br /> Soil Boring#: a�-�� —0 I 'j <br /> Drilling Company: «�� -�t< Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: AgCoM Filter Pack From: To: <br /> Geologist: irBentonite From: To: <br /> — <br /> j 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: Ift— height <br /> 79— _WWT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLEMN C11=10N <br /> Method: G=nd Swfaco <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> n. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No — m <br /> If yes, spoils storage Location: stoned <br /> Boron — <br /> Covered: ❑ Yes ❑No — <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �P'( 5 r _— <br /> Depth to Water: It f 4 <br /> Grout Material: e, UNV,4'1 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 5S <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 06oring Destruction <br /> I Bags of Cement: <br /> METHOD USED d = Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity E,�remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> alions Bas gallons Bags <br /> Thickest Thinnest VBags Thickest Thinnest 9Bags 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 /> 17.5 35 7 1 35 70 7 <br /> 20 40 8 40 80 8 <br /> G)it 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 www.s'cehd.com <br />