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J <br /> SANJOAQUIN <br /> _ Environmental Health Department <br /> COUNTY— <br /> \ <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector:x„_Satte n CONSTRUCTION <br /> Facility Address: q{ Fj NN- LQthrov Qd 95b&_ <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Ke th Cac;r-t, Wt\xr_ e, }�,_,� <br /> Screen Length From: To: <br /> Driller Onsite: <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: height <br /> SAMPLING Agpyg.61RWND <br /> Holding Temperature: COWPLSi10N oN <br /> Method: G=nd Suiacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Noft- <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r <br /> If yes,spoils storage Location: <br /> stottW .S <br /> sscon '' '— <br /> Covered: ❑ Yes ❑No9­01 Pack <br /> If yes, material: = <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 25k GroutMaterial: Pn'tOmf ?alletb <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction gags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> allons Bas R31111 ons 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 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 /> bacy- 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 I F 209 464-0138 1 www.swcehd.com <br />