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SAN JOAQUIN <br /> Environmental Health Department <br /> — <br /> COUNTY <br /> lti=oa�a�P Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> -,L� <br /> Date: Inspector: �S r CONSTRUCTION <br /> FacilityAddress:kb�� T 7-roct1 mqf Pott/ 6 KA4',',�/lq(t <br /> Well Address: `� r Total De' the <br /> WP# G(. Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite; <br /> Consultant: r Filter Pack From: To: <br /> Geologist: ArAlly 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: ITTLT height <br /> SAMPLING A OVE-GRCUNo <br /> Holding Temperature: OONFLl rtoN ccoMPLEnoN <br /> Method: Ground Surface <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No = <br /> C <br /> If yes,spoils storage Location: etonnd <br /> secyon <br /> Covered: ❑ Yes ❑No = vvi pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: � 2— <br /> Depth to Water: n• tt' <br /> Grout Material: tjP611C&MAAr <br /> 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 �oring Destruction Bags iz 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 471 Water Cement 941b <br /> allons s allons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest #Bags 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 /> J 1 <br /> 5b"- w/2� waw- 62 - S bad v�'/�J 9� 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 />