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0P� _. <br /> SAN�J OAQU I N Environmental Health Department <br /> b7i t4 <br /> —COUNTY— <br /> �O�cr��aP/ Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ? Inspector: CONSTRUCTION <br /> I �"1 Y���� �<< ��,c <br /> Facility Address: Lr?T <br /> Well Address: Total Depth: <br /> WP# c0 q t5�-\ Well#: Drilling Rig Type: <br /> Soil Boring#: C F ' Z'= - c t <br /> Min 2"Annular EHD Seal Verified: E] Yes El No <br /> Drilling Company: /mac i, rix <br /> Driller Onsite: "V.' /t Screen Length From: To: <br /> Consultant: 119 us- Filter Pack From: To: <br /> Geologist: l 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: W— T <br /> height <br /> SAMPLING ASVE-GROUND <br /> Holding Temperature: COMPLETION ca,,PtE'nCN <br /> Method: Ground Suulact <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes El No <br /> R. <br /> ft. <br /> SPOILS <br /> k; <br /> = o <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: abed = <br /> Batson — B <br /> Covered: ❑ Yes El No = 9-61 Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 7 n- n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> g J ]Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity gTremie ❑Other: Type of Method: <br /> at 2r cement 411b Water Cement 94 lb <br /> a ns gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest aYBags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 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 />