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SAN J OAQ U I N Environmental Health Department <br /> COUNTY— <br /> "Ikopoo`y' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Q 1/// Inspector: (Q CONSTRUCTION <br /> Facility Address: �I/1 lsoYL� /1�arylriSlOu�Lf <br /> Well Address: Total Depth: <br /> WP# ©t) Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: paMin 2"Annular EHD Seal Verified: El Yes El No <br /> s <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ( o SfpGi Filter Pack From: To: <br /> Geologist: `C0.t�(p/� 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 ❑NoWT <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GRCLJND <br /> Holding Temperature: COMPLETION CCCMP�tEncN <br /> Method: G=nd Sudwe <br /> Screening Method: a►oul <br /> Verified Chain of Custody: ❑ Yes El No �R- <br /> tt. <br /> SPOILS ; <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> soc:ion <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: CX =_ <br /> Depth to Water: <br /> MKQ-- <br /> Grout Material: <br /> Gallons of Grout Used: L7, q a4(a wS <br /> MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring InstallationI.Qtoring 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 *&TrPmi ❑Other: Type of Method: <br /> Water Cement 71 Water Ceme 4lb <br /> allons Bas Fallons Ba <br /> Thickest Thinnest 4Bags Thickest Thinnest ttBags 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 /> 6 20 40 8 40 80 8 <br /> 1 a bap6 9 I 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 09 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />