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;O QUr, <br /> SAN J OAQ U I N Environmental Health Department <br /> Kj <br /> -COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: O I In pect r: W�� CONSTRUCTIONOil <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# 00.315Well#: Drilling Rig Type: <br /> Soil Boring#: r Min 2"Annular EHD Seal Verified: ❑ 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 El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 11 No casing <br /> If yes, location and distance: height <br /> ii <br /> SAMPLING ABOVE-GROUND <br /> COMPLETION GfiFi3STY-80X <br /> Holding Temperature: MAREMN <br /> Method: Ground Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ElYes ❑No �ft' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = <br /> If yes,spoils storage Location: ,b : — <br /> socdon x <br /> Covered: ❑ Yes ❑No = g,,,ol <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ =_ <br /> Depth to Water: -- M tt. <br /> Grout Material: �Qo <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El 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 ❑Tre - ❑Other: Type of Method: <br /> Water Cement 47 lb water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest Thickest Thinnest 1t Bags Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 1 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 15 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 /> 2 2 b Aa& <br /> Vj/ 6 6 vv�✓ 10/16/2017 <br /> 1868 E. Hazelton Avenue to�California 95205 T 209 468-3420 F 209 464-0138 www.swcehd.com <br /> I I I I � <br />