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z SKJOAQUIN Environmental Health Department <br /> COUNTY <br /> cquFo�;N�% Greatness grows here. <br /> Monitoring LWell/Soil Boring Inspection Report <br /> Date: (y 20 Inspector: CONSTRUCTION <br /> Facility Address: 2kaH <br /> Well Address: Total Depth: <br /> WP# (,) J10 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: CGtG Min 2" Annular EHD Seal Verified: ElYes EJ No <br /> Driller Onsite: <br /> Screen Length From: To: <br /> Consultant: ylv Filter Pack From: To: <br /> Geologist: KtgyZ p_ 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: COWaLEnON COMPLEMN <br /> Method: Groind Sw1we <br /> Screening Method: oroul <br /> Verified Chain of Custody: ❑ Yes El No �_ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> = o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: sbt�a <br /> sac�on _ <br /> Covered: ❑ Yes ❑No = g., +P.-k <br /> If yes, material: <br /> GROUTING or DESTRUCTION Tot I Depth: 1) <br /> Depth to Water: NO '.{2Y ft• ft' <br /> Grout Material: Oa:� <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water ement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest ags Thickest Thinnest s 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 11 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />