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poal' <br /> ,---� ' SAN�JOAQUIN <br /> ,, Environmental Health Department <br /> —COUNTY-y ! -- <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: � '0'10 Inspector: 3A_�Vuf CONSTRUCTION <br /> Facility Address: aytftuT / <br /> Well Address: Total Depth: �7 <br /> WP# 0 2 7 Well#: Drilling Rig Type: P <br /> Soil Boring#: CPTT Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: F6L,rq_K1 <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> 1�SddjllNu Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes III No COMPLETION ❑ stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION CCowinz ooN <br /> Method: GrDtind S"rl"' <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes,spoils storage Location: slotted <br /> Batson — B <br /> Covered: ❑ Yes ❑No <br /> g-VW Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTIr)KI Total Depth: �S <br /> Depth to Water: Arai n n' <br /> Grout Material: Wall, MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation8oring 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 [ Tremie ❑Other: Type of Method: <br /> WaterC e 471b Water Cement 941b <br /> allons a sgallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3%Mix 5% Mix <br /> 2.5 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />