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SAN JOAQUIN Environmental Health Department <br /> --COUNTY <br /> � -•ter.:: <br /> c"�1Foa?` Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I2 2\ Inspector: CONSTRUCTION <br /> Facility Ad ress: J?j� ?e,,sc1a y-,r) <br /> Well Address: Total Depth: <br /> WP# 00 •Nell#: Drilling Rig Type: <br /> Soil Boring#: o Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: lSYV`� <br /> Driller Onsite: Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist:�'QJeLkk� <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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETiON COMP�LEnoN <br /> Method: Ground Surf=* T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> sac�on <br /> Covered: ❑ Yes ❑No 9,,,W Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �ok <br /> Depth to Water: n• tt' <br /> Grout Material: bleat b tuv <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation EJ Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 14 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izallons Bag5 <br /> Thickest Thinnest uBags Thickest Thinnest NBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2 s 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 6 <br /> `1 <br /> )' 6 o� LAI` � +I�9� �voot f , ' 10/16/2017 <br /> 1868, E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.swcehd.com <br />