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SAN JOAQUIN <br /> Environmental Health Department <br /> . i. <br /> ---COUNTY Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: MIn pector:_0Q-Vi& Vt,}i � "CONSTRUCTION <br /> Facility Address:—,2-6- <br /> Well Address- Total Depth: <br /> WP# 00 340 t1 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: 'TPN✓'o-co h <br /> Driller Onsite: C-SS Screen Length From: To: <br /> Consultant: '[e r✓'dCv+1 Filter Pack From: To: <br /> Geologist: k <br /> 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: cotFLETtON c�OtiUn-EnON <br /> Method: GroundSw1 w* <br /> Screening Method: grout <br /> PA <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> n. <br /> n. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes,spoils storage Location: aloud <br /> ax7on — B <br /> Covered: ❑ Yes ❑No w __ <br /> If yes, material: <br /> GROUTING or DESTRUCTIONotal Depth: <br /> Depth to Water: n0 VWOJ Zr- <br /> Grout Material '4x o <br /> Gallons of Grout Used: 100 q o' (oyo' MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 1A Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas aallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest VBags 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 35 70 7 <br /> 20 40 8 40 80 8 <br /> 20 7C-- 6 FOAF 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 />