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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY---- <br /> °±t P Greatness grows Lerc. <br /> ff <br /> Monitoring Well/Soil Boring Inspection Report <br /> e <br /> Date: I � " Inspector: J �,( CONSTRUCTION <br /> Facility Address: �I'-(bb S ��,�(VL°Am D< <br /> Well Address: j Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: — <br /> �U Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: V <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: V' 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION MAPLEnoN <br /> Method: Ground Surlwe <br /> Screening Method: gfOut <br /> Verified Chain of Custody: ❑ Yes El No �_ft. <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: <br /> a�cdon <br /> Covered: ❑ Yes ❑No = g,,, 4 <br /> PaCK <br /> If yes, material: <br /> x <br /> GROUTING or DESTRUCTION Total Depth: tt f 20f t/ 5 A __ .• <br /> Depth to Water: 3� �t ft' tt' <br /> Grout Material: ��11 VcT 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 <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity 7Tremie ❑Other: Type of Method: <br /> Water ement 471b Water Cement 94 lb <br /> allons Bags-- gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest kBags 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 lb 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 /> 20 40 8 40 80 8 <br /> of 1��ap� � �od(UM w 0*-Y �Lf 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />