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SAN JOAQUIN <br /> Environmental Health Department <br /> � k. COUNTY... ...... <br /> .............. <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Dater Inspector: 0 1417— CONSTRUCTION <br /> Facility Address: ej <br /> Well Address: Total Depth: <br /> WP# 0q 06 Well#: Drilling Rig Type: <br /> Soil Boring#: a 2 C <br /> Drilling Company: VMin 2" Annular EHD Seal Verified: El Yes El No <br /> r� �Pt 0 <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: N c et/ 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 Y casing <br /> If yes, location and distance: I height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFL6nON CCOMPLEMN <br /> Method: G=nd SLrfa ce <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No X82 / r: = r <br /> - -7o K _ <br /> If yes, spoils storage Location: t slattedice i qS <br /> s�cJon <br /> Covered: El Yes ❑No 4 = gnavel pack <br /> If yes, material: �+ <br /> GROUTING or DESTRUCTION /T�o al Depth: 15 "t <br /> Depth to Water: 't' � <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring InstallationT�(Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity %Tremie ❑Other: Type of Method: <br /> Water Cemen 471b water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest tlBags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.s 5 1 5 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 _ C Q I D`_3 i��►,U Cid I^/`O t <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 w 1 <br /> 20 40 sC 40 go s COvi�✓r>`C r- P��Vi Qi C�,�,�� p C r�CIQg <br /> g n 7 4Q S 2 oZ �GLQ S �- �fl q 0, 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.s'cehd.com <br />