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SAN JOAQUIN Environmental Health Department <br /> oti COUNTY-- <br /> Greatness <br /> -Greatness grows herr <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: b1_0 Ins ector: 1 - CONSTRUCTION <br /> Facility Address: 0_1 &j1_waA4 <br /> Well Address: Total Depth: <br /> WP# n 00 Well#: Drilling Rig Type: HS� <br /> Soil Boring#: At ""67Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: illfw' 'u1n41r1(,�.i'%1R(,� <br /> Driller Onsite: W��1 �Jf Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> i <br /> Geologist: �� IO/ 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: IFflT height <br /> off— —Crw—f <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLEr)ON CCOMPtET1oN <br /> Method: around Surtaos <br /> Screening Method: grout <br /> Verified Chain of Custody: ElYes El No �tt' <br /> tt. <br /> tt. <br /> SPOILS = <br /> w — . <br /> Contamination Noted: El Yes ❑No <br /> f3►-�30 <br /> If yes,spoils storage Location: a II slotted <br /> 4 2' s�c�on = S <br /> Covered: ❑ Yes El No <br /> va„a Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 6-3t>ft ?: <br /> Depth to Water: <br /> Grout Material: Neat P_ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 18oring Destruction <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 gTremie ❑Other: Type of Method: <br /> Water Cement 471b Water r <br /> allons Bas gallons <br /> Thickest Thinnest trBags Thickest Thinnest Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 5 10 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 z 10 20 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 <br /> 12.5 25 5 25 50 5 ,J�s 2Lt 9 wcCUA, <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 ? n Lj -155 (V w/ +LA " <br /> q '� at <br /> 20 40 8 40 80 8 1' J <br /> AW2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />