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SAN JOAQUIN Environmental Health Department <br /> --COU NTY-- - <br /> Ogoa Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z r/ Z()? Inspector: CONSTRUCTION <br /> Facility Address: v c- <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: �� (�; fty Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COIP�noN �t�F'noa <br /> Method: Gr°"rld Surface <br /> Screening Method: grout <br /> ..� <br /> Verified Chain of Custody: El Yes ❑No tL <br /> M <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No .TT. <br /> If yes, spoils storage Location: stoned <br /> n <br /> Covered: ElYes ❑No sc <br /> �"'�pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ' • __ <br /> Depth to Water: U n- fL <br /> Grout Material: & MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation VBoring Destruction Slot Size: <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 /> 9 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471 Water Cement 94lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 3% 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 40 8o 8 <br /> �- <br /> to 1 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s*cehd.com <br />