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SAN JOAQUIN <br /> COUNTY Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: _/IInspector: �0� CONSTRUCTION <br /> Facility A dress: <br /> Well Address: Total Depth: <br /> WP# (Do - Well#: Drilling Rig Type: <br /> Soil Boring#: — D-l'l Al , <br /> Drilling Company: n Min 2" Annular EHD Seal Verified: ❑ Yes El <br /> �lp�G (� <br /> Driller Onsite: v�Q..'1 / J Screen Length From: To: <br /> Consultant: eoc- lit O Scat O�- 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 AWVE-GROUND <br /> Holding Temperature: C0WPLPTION Ott P EMN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No - r tt. <br /> ft. <br /> n. <br /> SPOILS =_ <br /> Contamination Noted: ❑ Yes ❑No ♦ I r` <br /> If yes, spoils storage Location: I -70 abttad _ <br /> I-0^tid aK}on — B <br /> Covered: El Yes ❑No � _ 9-VW Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTI N Total Depth <br /> Depth to Water: I ft. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: a <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring InstallationPBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑GvPr/rill Filter Pack Type/Size: <br /> Gravity f�;Tremie ❑Other: Type of Method: <br /> Water Ceme 471b Water Cement 941b <br /> allons B gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest »Bags 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 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 1 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 /> f� y�I 10/16/2017 <br /> 1!868 E Hazelton Avenue 1S ockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />