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SAN JOAQUIN <br /> Environmental Health Department <br /> — COUNTY — <br /> . <br /> °4crFoaN�P Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:'3r -�L )10 Instor: d— 1 CONSTRUCTION <br /> Facility Address: 5 W. LA.(,Well Address: Total Depth: RS� iC� <br /> WP#O O Well#: Drilling Rig Type: <br /> Soil Boring#: /—16 q Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: V x W <br /> Driller Onsite: n Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: COWPLETION CLEncN <br /> Method: Ground SL face <br /> Screening Method: OfO"t <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> SPOILS tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: sbtt�a _ B <br /> on <br /> Covered: ❑ Yes El No <br /> grave,Pack <br /> If yes, material: ��.02, <br /> 20 <br /> 1 <br /> GROUTING or DESTRUCTION Total Depth: 0 �2 I <br /> Depth to Water: noile, 83' <br /> Grout Material: nle, 8�+ <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 l�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 /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 71b water Cement 941b <br /> allons Bas vallons Bags <br /> Thickest Thinnest tJBags Thickest Thinnest zBags 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 is 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 /> S4 j� a� S 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 />