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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness <br /> OUNTY—Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date l U InspectoCONSTRUCTION <br /> Facility Address-:- -310 TO 4✓Yfe ce rfre !& <br /> Well Address: Total Depth: �( <br /> WP# (on 3 s2o yp �SWell#: Drilling Rig Te: 4 Y Q <br /> Soil Boring#: 9 11 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: ��.�;�/n ]Q� GQo <br /> Driller Onsite: �i 001 Filter <br /> Length From: To: <br /> Consultant: 6.eo --6/it, i 4eer,* { ottDs f Filter Pack From: To: <br /> Geologist: A4-c 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: COWLETION COMPLEnON <br /> Method: G=nd Sumacs <br /> Screening Method: er«n <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> tt. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: ato�d <br /> sac an = 3 <br /> Covered: ❑ Yes ❑No = g-„w pack <br /> If yes, material: _= <br /> GROUTING or DESTRUCTION Total Depth: 7H '•�• __ . <br /> Depth to Water: a n- tL <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation iOBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity VTremie ❑Other: Type of Method: <br /> Water Cement 471b water 18 - <br /> 10/16/2017 <br /> allons Bas allons Bags <br /> Thickest Thinnest tfBags Thickest Thinnest Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 s 10 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 <br /> 10 20 4 20 40 <br /> 12.5 25 s 25 50 <br /> is 30 6 30 60 <br /> 17.5 35 7 35 70 <br /> 20 40 8 40 80 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />