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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> \� P Greatness grows here. <br /> Q Moonit�oring(We�llll/Soil Boring Inspection Report <br /> Date: / Ins ector: � r tD tV/2y�A CONSTRUCTION <br /> Facility Address: o e , i'Ve-, <br /> Well Address: Total Depth: n� 4 eo�� r� , ,�&r- <br /> SoilWP# 00 ?J� WelYl#: Drilling Rig Type: /_ILA �1 <br /> Boring#: -21 <br /> Drilling Company: Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> I ,✓t <br /> Driller Onsite: I Screen Length From: To: <br /> Consultant: Covlj o r Filter Pack From: To: <br /> Geologist: E 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 ABOVS-GROUND <br /> Holding Temperature: COWLETION ONWLETION <br /> Method: Ground Surtsos <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes L1 No <br /> it. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No r� <br /> If yes, spoils storage Location: 8f, �� r abtrad x' _ 0 <br /> . SV ,Nclon = .B <br /> Covered: El Yes El No n r _ gravel pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �Snf . EE <br /> IF E <br /> Depth to Water: 22 P4n' <br /> Grout Material: Alea* <br /> Gallons of Grout Used: 5� ua� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation .Boring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> gj x ity 9]Tremie ❑Other: Type of Method: <br /> / V� <br /> 15 <br /> Water Cemen Ib Water Cement 941b <br /> allons Bas eallans Bags <br /> Thickest Thinnest NBags Thickest Thinnest Bags 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 is 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 9 10/16/2017 <br /> 110 go,( 29 bagS <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s6cehd.com <br />