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SAN. JOAQUIN <br /> Environmental Health Department <br /> Q —COUNTY— <br /> , - - <br /> °� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: v ' l Inspector: � i D� - . CONSTRUCTION <br /> Facility Address: - 0 7*_y Fj <br /> Well Address: Total Depth: / <br /> WP# 0 Well#: Drilling Rig Type: /"I u) <br /> Soil Boring#: I- �)q Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: C''U- <br /> Driller Onsite: i (- Screen Length From: To: <br /> Consultant: C N zo7t%0 <br /> Filter Pack From: To: <br /> Geologist: L0 pvto✓ 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 Agpyg.GRpILINp <br /> Holding Temperature: COWLETION �COMP�LEnON <br /> Method: Ground Sur}aco <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> it. <br /> n. <br /> SPOILS - -' <br /> Contamination Noted: ❑ Yes ❑No " <br /> If yes, spoils storage Location: •tonal <br /> aKJon r <br /> Covered: ❑ Yes ❑No = c-v+pack <br /> If yes, material: <br /> �n ;PEE <br /> GROUTING or DESTRUCTION Total Depth: __ <br /> Depth to Water: WIF n' <br /> Grout Material: co <br /> Gallons of Grout Used: d,..1 MATERIALS/DEVELOPMENT <br /> �'�' Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation q oring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity 4Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest BBags Thickest Thinnest xBags Bentonite/Cement Mix 3% Mix 3%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 A 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 70 7 <br /> 20 40 8 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.s6cehd.com <br />