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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows het;. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: I 1 <br /> WP# � Well#: Drilling Rig Type: q '+ ; 3 CA <br /> Soil Boring#: If E�11—� Min 2"Annular EHD Seal Verified: ❑ Yes El No d <br /> Drilling Company: <br /> �5 Screen Length From: To: <br /> Driller Onsite: , <br /> Consultant: e; Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes fNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes LJN0 casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE.GgptJND <br /> Holding Temperature: COWPLENON COOMP�LE71$CN <br /> Method: G=r)d SLeac* <br /> Screening Method: groLn <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> SPOILS = <br /> = m <br /> Contamination Noted: ❑ Yes El No = r <br /> If yes, spoils storage Location: <br /> Covered: ❑ Yes ❑No = gr, d <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ <br /> Depth to Water: Ff_ ft ft' <br /> Grout Material: C <br /> zw� <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:_ <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> El Boring Installation§dBoring Destruction Slot Size: <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 /�T'remie ❑Other: Type of Method: <br /> 71 <br /> Water Cement 471b water Cement 941b <br /> allons Bas gallans Bags <br /> Thickest Thinnest #Bags Thickest Thinnest PBags Bentonite/Gement 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 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 2—. 35 70 7 <br /> 20 40 8 40 80 8 <br /> —:9 10/16/2017 <br /> kri e <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />