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SAN. JOAQUI�, <br /> Environmenital Health Department <br /> COUNTY---- <br /> Greatness grows here. <br /> + ` Monitoring Well/Soil Boring Inspection Report <br /> Date: t ` ! �� ins_pector: CONSTRUCTION <br /> Facility Address: 3 4 , <br /> Well Address- Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: 5 S l4 <br /> Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes ,ONo <br /> Driller Onsite: / y� p Scr o: �j— <br /> Consultant: _ Filt o: <br /> Geologist: 4 BentoniteFrnrn- <br /> Gro_ uu_t From- - —� <br /> L <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: COtwLEnoN �t.EnoN <br /> Method: end S"t"' <br /> Screening Method: o�an <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> SPOILSp <br /> Contamination Noted: ❑ Yes ❑No r` <br /> If yes,spoils storage Location: slotted <br /> saclon <br /> Covered: ❑ Yes ❑No = = gravel pack_ <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: .4. <br /> Depth to Water: M n' <br /> Grout Material: <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`�oring Destruction <br /> //`` Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Jl Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest #,W Thickest Thinnest IBags 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 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 1 80 8 <br /> 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 />