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SANsJOAQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: %v3 \)J• I��in�Q�V� SC <br /> Well Address: S'A Total Depth: <br /> WP# Well#,Jy� Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: 11 Yes ❑No <br /> Drilling Company:_(Taki(TICA <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: } F.utV\ Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: I ] Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes C N0 casing <br /> 7fIf yes, location and distance:If <br /> SAMPLING ABOVE-GROUND <br /> COA'F'LET10 <br /> Holding Temperature: N c0WILEi1110N <br /> Method: c3round Suiacs <br /> Screening Method: 9fOLA <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> ft. <br /> SPOILS r = o <br /> Contamination Noted: ElYes ❑No =` _ <br /> If yes, spoils storage Location: sbttQd = - <br /> i1CSCn y. <br /> Covered: ❑ Yes []No g,wal l <br /> ack <br /> If yes, material: . = _ <br /> GROUTING or DESTRUCTION Total Depth: O �.�• - =_ <br /> Depth to Water: 3a ft. ft' <br /> Grout Material: � Q�L—� ce. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> []Well Installation Owell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <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 iTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bento 'te/Cement Mix 3% MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonit er 47 Ib 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite r 94 Ib 1 2.821 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 /> 153 30 60 6 <br /> 17.5 7 35 70 7 \ <br /> 20 4 8 40 80 8 \ <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 www. ehd.com <br />