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SAN >JOAQUIN <br /> Environmental Health Department <br /> " t —COU NTY <br /> Greatness grows here. <br /> �/ Monitoring Well/Soil Boring Inspection Report <br /> Date: / Z `► Inspector: ( CONSTRUCTION <br /> Facility Address: 0 PE� <br /> Well Address: Total Depth: �Z/rC�1ClY�l,Q" CWS C l�Je.�� <br /> WP# D033ffM 36___Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: I �� in 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: <br /> u 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 El 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: COMPLETION CADW.ETtoN <br /> Method: Ground Surfaos <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No Ir <br /> n. <br /> tt. <br /> SPOILS <br /> — - e <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes, spoils storage Location: slotted <br /> soon <br /> Covered: ❑ Yes El No = �, <br /> If yes, material: ' <br /> GROUTING DESTRUCTION Total Depth: Uzi <br /> o Water: n• n' <br /> Grout Material: 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 ❑Boring Destruction 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 ❑Tremie ❑Other: Type of Method: <br /> Water ment 471b water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest bBags Thickest Thinnest 4Bags 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 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> b ,^f/-Z o w � 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />