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TO SAN IOAQUIN <br /> Environmental Health Department <br /> COUNTY - <br /> a ,, rFo Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : Insp ctor : CONSTRUCTION <br /> Facility Ad r S'SA00 c t � � <br /> Well Address : Total Depth : <br /> WP#� Zw Well # : CA 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 : ` L a '4 , Filter Pack From : To : <br /> Geologist : ' S 'cur'1 � ; <br /> 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 /> W7:F <br /> SAMPLING A180VEoGROUND <br /> Holding Temperature : COWLETION COOMPLEMN <br /> Method : Ground SuAacs <br /> Screening Method : Or«n <br /> Verified Chain of Custody : ❑ Yes ❑ No — n• <br /> it. <br /> SPOILS <br /> Contamination Noted : El Yes ❑ No <br /> If yes, spoils storage Location : ,,t�fj ttQd <br /> p &*=on = � <br /> Covered : ❑ Yes El No <br /> Vivo! Pack <br /> If yes, material : <br /> GROUTING or DESTRUCTION Total Depth : wail. = <br /> Depth to Water : k5e n• ?" tt• <br /> Grout Material : w C% ) MATERIALS/ DEVELOPMENT <br /> Gallons of Grout Used : C Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation ❑ Slot Size : <br /> Boring Destruction gags Size : <br /> 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 C ent 471b Water Cement 94 lb <br /> allons Bas allons Bags <br /> Thickest Thinnest pBags Thickest Thinnest Bags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> 2. 5 5 11 5 10 1 Bentonite per 47 Ib 1 .41 2047 <br /> 5 10 21 10 20 2 Bentonite per 94 Ib 2082 4 . 7 <br /> 7. 5 15 31 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12. 5 25 5 25 s0 5 <br /> 15 30 6 30 60 6 <br /> 17. 5 35 7 35 70 7 <br /> 20 40 177 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. secehd . com <br />