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QpnuiN c <br /> SAN JOAQUIN Environmental Health Department <br /> 1" COUNTY <br /> cq` j/ Greatness grows here. <br /> (� Monitoring Well/Soil Boring Inspection Report <br /> �- 7 <br /> Date: Inspector: o"r-to, 4 CONSTRUCTION <br /> Facility Address: to <br /> Well Address: Total Depth: <br /> WP# () S Well#: Drilling Rig Type: PT 2 I �� 4* �y <br /> Soil Boring#: --12Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Compan : t-/-w 14 6Z /e l <br /> Driller Onsite: I" Screen Length From: To: <br /> Consultant: 7tvill-AeLk kto Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 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: COMPLETION MAPPLE•TfoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No -�-n' <br /> ft. <br /> h. <br /> SPOILS p <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abs ! <br /> a+cJon — B <br /> Covered: El Yes El No - ^ gra„wP&* <br /> If yes, material: <br /> GROUTING or DESTR CTION Total Depth: J� ' • __ <br /> Depth to Water: -S f n- ft. <br /> Grout Material: ^k CF;r ,�n� <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: a Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation 5lboring 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement`Ib Water Cement 941b <br /> allons Sag aallons Baes <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 so 5 <br /> 15 30 6 3060 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> C 1 . 5 b,J 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />