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SAN JOAQUIN Environmental Health Department <br /> uqul, ` COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: h2dis Inspector: 44QAOMti CONSTRUCTION <br /> Facility Address: <br /> Well Address: bri&A Total Depth: <br /> WP# Ha-7 -733 Well#: Drilling Rig Type: <br /> Soil Boring#:�� Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: — <br /> Driller Onsite: Screen Length From: To: <br /> z� Filter Pack From: To: <br /> Consultant: j jC, <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: COAFLE710N COMP�t.EnoN <br /> Method: Ground Sixf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No tt' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes 11 No =` <br /> If yes,spoils storage Location: stottad <br /> scion — 3 <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �J =_ <br /> Depth to Water: tt• tt' <br /> Grout Material: 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 /> 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 ATremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas ga111111 ons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix 3% 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 10 4 20 40 4 <br /> 12.5 25 5 25 SO 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.slcehd.com <br />