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�N �) _ Environmental Health Department <br /> °�2 SAN�IOAQUIN <br /> COUNTY <br /> °,7 Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I g Inspector: CONSTRUCTION <br /> Facility Address: Z v (I W <br /> Well Address: c ( Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: ri Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: :� Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: ze r <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 0 N 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 cCOMPLEMN <br /> Method: Ground Surtacn <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt. <br /> it. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = e <br /> If yes, spoils storage Location: slotted = . <br /> seron — <br /> Covered: ❑ Yes El No = g-Wpzck <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ ( y is <br /> Depth to Water: <br /> Grout Material: lqteiq_ A y MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destru ion Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring InstallatioBoring Destruction <br /> Bags of Cement: <br /> METHOD USED ' gs Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill t.A, ype/Brand of Bentonite: <br /> 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 ttBags Thickest Thinnest 4Bags Bentonite/Gement Mix 3% Mix 5% Mix <br /> 2.s- 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 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 i 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s*cehd.com <br />