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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> // Monitoring Well/Soil Boring Inspection Report <br /> Date:��t(L—� ns ector: NIf- e-6 CONSTRUCTION <br /> Facility Address: /k gwAl � f 1 <br /> Well Address: Total Depth: <br /> WP41690y�3 311 Well#: Drilling Rig Type: <br /> Soil Boring#: 56-1 ti3 H f /D /F z <br /> Drilling Company: 1�;ie-C6' Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> DrillerOnsite: Screen Length From: To: <br /> Consultant: r y Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: P height <br /> SAMPLING ABOVEGROUND <br /> COMPLETION CON <br /> Holding Temperature: COMPLETION <br /> Method: Grroundsuixs <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑Non• <br /> —ft. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ONO ,'•' = ' <br /> If yes,spoils storage Location: �bnad ` <br /> suction <br /> Covered: El <br /> ONO �g <br /> If yes,material: , / I*lEi Pack <br /> Sg <br /> GROUTING or DESTRUCTION Total Depth: [O , /� f; = •. <br /> Depth to Water: <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: y'�� i/lr. Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation1@oring 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 /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags allons Seas _ <br /> Thickest Thinnest kBags Thickest Thinnest 4aags _ BentonitelCement Mix 9% MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite er47lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 35 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 BO B <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 />