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SAN_JOAQUIN Environmental Health Department <br /> —COUNTY--- - <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3 1241 701 Inspector: Sauvut CONSTRUCTION <br /> Facility Address: 4f CA16S Max <br /> Well Addrs: Total Depth: <br /> WP# 6b �iD�l Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> /� <br /> Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <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 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: COlFLrtON C-OMP1FncN <br /> Method: Ground Surlacs <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes El No L�ft. <br /> H. <br /> ft. <br /> SPOILS <br /> Y1 Y <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> 0 <br /> abttsd c <br /> arc.on <br /> Covered: ❑ Yes El No = � <br /> If yes, material: ( 7rogt _(Z'eaL ~, <br /> GROUTING or DESTRUCTION Total Depth:_ "� : <br /> Depth to Water: h• _ n• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation *Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity I1Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest HBags Thickest Thinnest uBags 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 15 3 15 30 3 <br /> 10 20 4 20 40 4 S �` + 2 a(,(c lH► 0 <br /> 1 25 5 25 50 5 ��(� (� tJ <br /> 15 30 30 60 <br /> 17.. 7 75 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.s*cehd.com <br />