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l <br /> SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows her, <br /> Monitoring Well/Soil Boring Inspection Report i3 �i 8 Uairyt(�(p� <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: 2 7[ �` a t�1a U 6r' a <br /> Well Address: Total Depth: <br /> WP# ?) Well#: Drilling Rig Type: CC) <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND " <br /> Holding Temperature: COWLET1ON COMPLET71CN <br /> Method: Gemnd Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> SPOILS E <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: 8� 3'D�t slotted <br /> arc:on = <br /> Covered: ElYes []No <br /> If yes, material: <br /> GROUTING or DEST CTION Total Depth:2U-50ft <br /> Depth to Water: c) Tt �J� 2Q--y—ft• — tt' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction <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 471b Water Cement 941b <br /> allons Bags i4allons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest :t Bags 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 25 5 25 50 5 <br /> 15 07 30 60 6 <br /> 17.5 35 35 70 7 <br /> 20 IS a uo ao s <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />