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SAN JOAQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I ho w Inspector: ! CONSTRUCTION <br /> Facility Address: 1223 <br /> Well Address: Total Depth: <br /> WP#00 q 0 4 (oWell#: Drilling Rig Type: <br /> Soil Boring#: 6 l -1)3 <br /> Drilling Company: ��r✓ACo✓7 Min 2"Annular EHD Seal Verified: ❑ Yes E-1 No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 'r�✓Guc.oyl <br /> Filter Pack From: To: <br /> Geologist: LALC- b-, 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: COWLErtON CCCUPLEMN <br /> Method: Ground Surface <br /> Screening Method: Of out <br /> Verified Chain of Custody: ❑ Yes El No n <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No ` <br /> If yes, spoils storage Location: slotted <br /> secdon <br /> Covered: ❑ Yes ❑No/1�{S�1 - gravelpackIf yes, material: �1 172; �I <br /> GROUTING or DESTRUCTION Total Depth: r <br /> Depth to Water: M n' <br /> Grout Material: <br /> (gam y 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 of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> tg Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 94 lb <br /> allons Bas Rall ons Bags <br /> Thickest Thinnest #Bags 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 /> 10 204 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 /> 139 <br /> l3g q Xt ;3 btl S 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 />