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SAN JOAQUIN Environmental Health Department <br /> =r' COUNTY - <br /> / <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: S I e �rwP 'b� �� Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: 1 eo;'t; v�CJ �rc< < r�� i t 1,n Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: 1}[6< <br /> —�� 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 El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING A80VE-GROUND <br /> Holding Temperature: CotF�TION noN <br /> Method: Ground Surf"' <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No -�—n' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes 11 No ` <br /> If yes, spoils storage Location: slotted <br /> s�cdon r — <br /> Covered: ❑ Yes ❑No =' <br /> or vW pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: • __ <br /> Depth to Water: n- n' <br /> Grout Material: W+ort,; � <br /> Gallons of Grout Used: ���{ ga(lovtr• 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 /> ❑ Gravity [!Tremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> allons Bas izallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% 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 ��'�J1�Y7 kA <br /> L- <br /> 17.5 <br /> 17.5 35 7 35 70 7 I�, <br /> 20 40 B 40 80 8 rJ r3 Qf S / 9, <br /> r so <br /> ( <br /> � Q•••wJJJK/]�� 6 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209014'68-3420 1 F 209 464-0138 1 www.s'cehd.com <br />