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a" SAN JOAQUIN <br /> � � Environmental Health Department <br /> " 16CI,:.' <� — COUNTY <br /> Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : Inspector : A4% t&4% CONSTRUCTION <br /> Facility Address : `( $b # • Loy .Se Atev%,4, <br /> Well Address : Total Depth : <br /> WP#mqz. 7 Well # : rel - 3, Drilling Rig Type : <br /> Soil Boring# : Min 2 " Annular EHD Seal Verified : ❑ Yes [] No <br /> Drilling Company : <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : � � (�. tn Filter Pack From : To : <br /> Geologist : �i, u., 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 : 2 height <br /> W7;F <br /> SAMPLING a sovE-GRCUND <br /> Holding Temperature : COWPLETION cLEncN <br /> Method : G=ndSuixv <br /> Screening Method : or«n <br /> Verified Chain of Custody : ❑ Yes ❑ No � Re <br /> n. <br /> ft. <br /> SPOILS <br /> ew <br /> Contamination Noted : ❑ Yes El No <br /> If yes , spoils storage Location : <br /> sacdon <br /> Covered : ❑ Yes ❑ No <br /> VIVVI Pack <br /> If yes , material : <br /> EE <br /> GROUTING or DESTRUCTION Total Depth : 2.v � _ <br /> Depth to Water : ill ft• <br /> Grout Material : N �•'✓f G'^y <br /> Gallons of Grout Used : MATERIALS/ DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation GAell Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> El 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 [a remie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest gBags Bentonite/Cement Mix 3 % MIX 5 % MIX <br /> Is 5 15 10 1 Bentonite per 47 Ib 14411 2 .47 <br /> s 10 z 10 zo 2 Bentonite per 94 Ib 24821 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 <br /> 17. 5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 9 10/ 16/2017 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 F 209 464- 0138 www. secehd . com <br />