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SAN JOAQUIN Environmental Health Department <br /> " Lf "• COUNTY <br /> Greatness grows here. <br /> Monitoriin"g..Well/Soil Boring Inspection Report <br /> Date: 26 Iq Inspector: r n CONSTRUCTION <br /> Facility Address: 1Q � ► ` )��r DYl �n <br /> Well Address: Total Depth: cc, o�C <br /> WP#d 31 q 3 3 S Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: (�_w2f (i <br /> Driller Onsite: Jt `' Screen Length From: To: <br /> Consultant: rA/yf rI s; nc�hiye Filter Pack From: To: <br /> ��I,yL 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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION COMPLETION <br /> Method: Ground Surf=* <br /> Screening Method: oro�t <br /> Verified Chain of Custody: ❑ Yes El No �tt• <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: abnad <br /> ,►codon <br /> Covered: ❑ Yes ❑No gra„a pack <br /> If yes material: _= <br /> OUTING r DESTRUCTION Total Depth: <br /> 3 — <br /> De o Water: — n• tt' <br /> Grout Material: No Q"f <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> L 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 Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest BBags Thickest Thinnest cgs 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 2 30 <br /> 10 20 4 20 40 <br /> 12.5 25 5 25 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 2 1 40 8 1 40 80 8 <br /> Z ba.0f �/\J (-v�j g(/�,l�t� y,J a#j 1' l�(`� 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />