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' SAN-JOAQUIN <br /> Environmental Health Department <br /> •" —COUNTY- <br /> 1S I <br /> Greatness qrows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Ins ector: `/l t CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes 1-1 No <br /> Drilling Company: Q -elir <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑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: COWLS ION COOWLEET OON <br /> Method: Ground Strf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes E]No ft- <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: El Yes ❑No =` <br /> If yes,spoils storage Location: s�attQd = 71 <br /> Yvu�d � <br /> Covered: ❑ Yes ❑No <br /> sxi++n+Fads <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:7to <br /> Y _ <br /> Depth to Water: 2 3 d t�"1Vf' J �0[e, ft• <br /> Grout Material: c ° g0 cis MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑BSlot Size: <br /> oring Installation ❑Boring Destruction gags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags Fallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 55%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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />