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CLF6'i�'� <br /> SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector:T&6I a, A CONSTRUCTION <br /> Facility Address: C� <br /> Well Address: Total Depth: Ll <br /> WP# 0 Well#: Drilling Rig Type: <br /> Soil Boring#: t — Q_ <br /> Drilling Company: sou P� Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: 50 Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GRot1ND <br /> Holding Temperature: COWL.EMN COMPLETION <br /> Method: Ground Surface'+ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —'ft' <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No ` <br /> If yes,spoils storage Location: i abttaa <br /> Zo ..�°n r <br /> Covered: ❑ Yes El No �jI = gravolaack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 55 i r ( � <br /> Depth to Water: 16 61 h1 -:10 <br /> 0t <br /> Grout Material: �j 4 <br /> Gallons of Grout Used: L MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring InstallationVBoring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Q Filter Pack Type/Size: <br /> ✓3/ aNgGravity gTrreemlea ❑Other: Type of Method: <br /> Water Cemen 71b Water Cement 941b <br /> allons Sag gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest NBags 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 /> 10/16/2017 <br /> 1868 E.Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />