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°Y`" SAN JOAQUIN Environmental Health Department <br /> t.. <br /> " .:!I ---COUNTY <br /> Greatness grows her, <br /> p� Monitoring Well/Soil Boring Inspection Report <br /> Date: I Inspector: "xt CONSTRUCTION <br /> Facility Address-.— mfl-,,k to . <br /> Well Address: Total Depth:_ , /' <br /> WP# Well#: Drilling Rig Type: 2�Q(►ar4jttt, CPT <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: � l � i� Filter Pack From: To: <br /> Geologist: 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION c�1EncN <br /> Method: G=n°Surlacs <br /> Screening Method: groul <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft.it. <br /> ft. <br /> SPOILS = <br /> — o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> 0 <br /> slottod _. 5 <br /> arc..n <br /> Covered: ❑ Yes ❑No = VW w <br /> ck <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ :.,. <br /> Depth to Water: n• = tt <br /> Grout Material: tjQ4 aZA�A—T <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installationoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity TxTremie ❑Other: Type of Method: <br /> Water ment 471b Water Cement 94 lb <br /> allons I Bas gallons Bags <br /> Thickest Thinnest ags Thickest Thinnest NBags 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 <br /> 12.5 25 5 25 j 50 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 5 at,r!�. '41 b'— � 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />