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SAN JOAQUIN <br /> -----COUNTY-- Environmental Health Department <br /> C9C�PORN�P� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I Inspector: 1 CONSTRUCTION <br /> Facility Address:_ �j� .moi <br /> Well Add re s Total Depth: <br /> WP# 0 Well#: Drilling Rig Type: /rJ <br /> Soil Boring#: l <br /> Drilling Company: - a o��,-� Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Driller Onsite: ' VV M Screen Length From: To: <br /> Consultant: CTF cps -3:n Filter Pack From: To: <br /> Geologist: A Ioan 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 /> ±moNHolding Temperature: CONFLE ION « t.En <br /> Method: Ground Sudwe <br /> Screening Method: grotA <br /> Verified Chain of Custody: ❑ Yes El No <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: abnaa = . <br /> B► - I s soclon <br /> Covered: El Yes ❑No _ - t-volpack <br /> If yes, material: 12� 3 I / <br /> n. n. <br /> GROUTING or DESTRUCTION Total Depth:3-,'S 3' ' <br /> r <br /> Depth to Water: <br /> Grout Material: 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 /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 4Bags Bentonite/Gement 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 1 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 2l�l 6 S 10/16/2017 <br /> 1868 E. Hazelton Avenue I S ockton, California 95205 1 T 209468-3420 F 209 464-0138 www.sjcehd.com <br />