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oPuu+ti�. <br /> 2' SAN JOAQUIN <br /> Environmental Health Department <br /> k <br /> —COUNTY-Greatness grows here. <br /> p Monitoring Well/Soil Boring Inspection Report <br /> Date: 2"'I Inspector: CONSTRUCTION r <br /> Facility ddre s: 7� b <br /> Well Address: Total Depth: <br /> WP# ()o 4002,b Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: \/ <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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLEMN �t- BOX <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No n' <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No >` <br /> If yes, spoils storage Location: <br /> slatted = - <br /> sacJon !K _ <br /> Covered: ❑ Yes ❑No gr,,:,w P-Ck <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 29—ft '3 <br /> Depth to Water: h1b Y <br /> Grout Material: N e0t CMIALki MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation oring Destruction Slot Size: <br /> lllfff""" Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout []Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest riBags 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 IS 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 SO 8 <br /> 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 />