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SAN JOAQUI Environmental Health Department <br /> —COUNTY— <br /> vreotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: T Inspector: - <br /> CONSTRUCTION <br /> Facility Address: r ;�, <br /> Well Address: Total Depth: <br /> WP# ©O 3A �� Well#: ( Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ vac F-1Nr)Drilling Company: 62 D <br /> Driller Onsite: p b Screen Length From: _ ,15 :o:_ � �r <br /> Filter Pack From: -� �> �To:_ _ <br /> Consultant: {'r'" ` <br /> Geologist: .rt4� Bentonite From..- _ To: t77. <br /> Grout From: To:—`- <br /> Public Water System Onsite: ❑ Yes ON COMPLETION ❑ Stove Pipe AChristie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: height <br /> 19 <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: DOw�T1ON ccotPeN <br /> Method: l D G=ndSuiacs <br /> Screening Method: Sd f I aroLn <br /> Verified Chain of Custody. ElYes ONO t q l� n• <br /> SPOILS <br /> Contamination Noted: ❑ Yes 11 No No <br /> If yes, spoils storage Location: <br /> f NeX stolid <br /> s\ sacdon <br /> Covered: El Yes []No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water:— 2-S S n ✓ <br /> Grout Material: /IPA::t C MATERIALS/DEVELOPMENT / � <br /> Gallons of Grout Used: � -F S Casing Type: p VC q0�C�` lJ <br /> Well Installation ❑Well Destruction Blank 20 Feet Screen 157 Feet <br /> ❑Boring Installation ❑ Slot Size: © DBoring Destruction Bags of Cement: rP <br /> METHOD USED Bags Sand/Gravel: Z <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: ` <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas Rall ons Bags <br /> Thickest Thinnest kBags Thickest Thinnest 11 Bags 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 25 511- 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 35 70 7 <br /> 20 40 8 40 80 8 <br /> 6/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.s*cehd.com <br />