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SAN JOAQUIN Environmen al Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> S f Zo <br /> Date: I� nspector: CONSTRUCTION <br /> Facility Address: - 1 �1 <br /> Well Address: Total Depth: 1� <br /> WP# 0 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: ,' Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: A 74 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING J180YE-6ROMD _ <br /> Holding Temperature: 0OWPLEr10N EriON <br /> Method: Grwndsuiac*—:F <br /> Screening Method: o� <br /> Verified Chain of Custody: 11 Yes ❑No n' <br /> ti. <br /> it. <br /> SPOILS — <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotud .. <br /> s�c3on <br /> Covered: ❑ Yes ❑No ,,,i Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: I '�2 L� "� • <br /> Depth to Water: 1 1 <br /> /� n' <br /> Grout Material: ���__—c le41 Z MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installatio"t QBoring Destruction Bags of Cement: <br /> METHOD USED JV/'' Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> `'_Gravit ,Tremie ❑Other: Type of Method: <br /> ✓✓ ,c R <br /> Water aCementb Water Cement 94lb <br /> Ilons allons Ba s <br /> Thicke innest Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 l0 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 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 />