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SAN. JOAQUIN <br /> , (( Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> nn Monitoring Well/Soil Boring Inspection Report <br /> Date: Av9lnspector� CONSTRUCTION <br /> Facility Address: 0o W, <br /> Well Addres : Total Depth: <br /> WP# 0 0 LO '7— Well#: Drilling Rig Type: �^( <br /> Soil Boring#: 9 to12 2Z Z y(1462 6 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Lf=l do 4f <br /> Filter Pack From: To: <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 ❑No casing <br /> If yes, location and distance: IFTLT- height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETfON C�tFnoN <br /> Method: G=nd Surlac* <br /> Screening Method: (� I ru I I gran <br /> Verified Chain of Custody: ❑ Yes El No 'IJZ; I (9 `---n: <br /> SPOILS <br /> -2 <br /> Contamination Noted: ❑ Yes ❑No '✓ l 2" �I >` <br /> If yes, spoils storage Location: ��Z Bien d <br /> scion - — A <br /> Covered: ❑ Yes ❑No �Z 1 �S <br /> viW pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:L V(� ' • __ <br /> Depth to Water: O�- it. n' <br /> Grout Material: V Co'/' <br /> Gallons of Grout Used: Za O q 0,)) MATERIALS/DEVELOPMENT <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 Filter Pack Type/Size: <br /> IL LGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Bas gall ons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 9Bags 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 /> 20 40 8 40 80 8 <br /> f Z- '� I I 1� � 10/16/2017 <br /> 11868 E. Hazelton Avenue Stoci(ton California 95205 T 209 468-3420 F 209 464-0138 www.s'cehd.com <br /> I I I I I <br />