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SANmJOAQUIN <br /> a Environmental Health Department-COUNTY-Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspectol )W4 CONSTRUCTION <br /> Facility Address:-4:1 ZZ <br /> Well Address: l Total Depth: <br /> WP# ©QZAJ to Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <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 []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: T height <br /> SAMPLINGAgpyE-GROUND —c"r-T <br /> Holding Temperature: COWLETION ciEMN <br /> Method: G=ndSurface �+ <br /> Screening Method: erl«n <br /> Verified Chain of Custody: ❑ Yes ❑No —`---n' <br /> tt. <br /> IF— <br /> ft. <br /> SPOILS : <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: stoned = . <br /> &*cion <br /> Covered: ❑ Yes ❑No <br /> gi vi Pack <br /> If yes, material: _= <br /> GROUTING or DESTRUCTION Total Depth:�� <br /> Depth to Water: <br /> Grout Material: Pe"'t Qwu.yc�- <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 Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity C`�'fremie ❑Other: Type of Method: <br /> Water ement 47lb' water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest 11 Bags BentonitelCement 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 /> 21 -Aq,�, V�/N 60 qi, , iN- V 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br />