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UIA <br /> SAN,JOAQUIN <br /> N � Environmental Health Department <br /> —COUNTY— <br /> Greatness Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: B&51 Ll9 Inspector: CONSTRUCTION <br /> Facility Address: 0 F <br /> Well Address: Total Depth: <br /> WP# S S Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Companw. Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite• •-1 1� yL,� Screen Length From: To: <br /> , c1Filter Pack From: To: <br /> Consultant: <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 El No casing <br /> If yes, location and distance: ITTLT height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COA�°�nON noN <br /> Method: G=nd Surfwo <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> h. <br /> SPOILS ;. <br /> Contamination Noted: ❑ Yes ❑No =` <br /> If yes, spoils storage Location: slotted <br /> LK90n r <br /> Covered: ❑ Yes El g.No _ w+ <br /> If yes, material: <br /> x. <br /> GROUTIN r DESTRUCTION Total Depth: <br /> to Water: <br /> Grout Material: Qil�t �. ?n � �� f <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity NTremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest ABags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 50 5 <br /> 130 6 30 60 6 � LA)/ <br /> 17..5 35 7 35 70 7 ►u 0t� �1. r 1, <br /> 20 40 8 40 80 8 (� i'jlett <br /> 14 y 0/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.slcehd.com <br />