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SAN J OAQ U I N Environmental Health Department <br /> --COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:3 Z I/ Zoo Inspector: W CONSTRUCTION <br /> Facility Address:__j 2 0$Q <br /> Well Address: Total Depth: ASA /" y <br /> WP# Well#: <0 Drilling Rig Type: ASA (� <br /> Soil Boring#: 3 <br /> Drilling Company: �— � Q-�/� P Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> � . Screen Length From: To: <br /> Driller Onsite: 1�Z ZO <br /> Consultant: ��� Iter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes [I No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLET{ON cOW�ON <br /> Method: Ground Surla v If <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No " ft. <br /> ft. <br /> SPOILS — <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stotmd <br /> a on Of. '— <br /> Covered: ❑ Yes ❑No <br /> w Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: — <br /> Depth to Water: N 0-' r tt• tt. <br /> Grout Material: P,mLyzk- <br /> Gallons of Grout Used: U­ <br /> Casing <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction � Blank Feet Screen Feet <br /> ak <br /> ❑Boring Installationoring Destruction Slot Size:Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> XGravitV remie ❑Other: Type of Method: <br /> � Z <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas 9,allons 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 15 3 15 30 3 <br /> 10 20 4 20 40 4 q <br /> 1 25 5 25 50 5 / <br /> 155 30 6 30 60 6 <br /> 10 35 7 35 70 7 / <br /> 20 40 B 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />