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SAN JOAOUIN Environmental Health Department <br /> COUNTY--......_.. <br /> :sqL / Greotness grows here. <br /> �j Monitoring Well/Soil Boring Inspection Report <br /> Date:`_7h L-1 �WInspector:\Do- 14. CONSTRUCTION <br /> Facility Address: 1-j-2_0 W Vf 2fd 1114 <br /> Well Address: Total Depth: �S <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: I Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: oiq <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: o Filter Pack From: To: <br /> Geologist: G�►r-�� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 006FLETION cchAPtEncN <br /> Method: Ground Surfecy <br /> Screening Method: Drart <br /> Verified Chain of Custody: ❑ Yes ❑No —`--n' <br /> H. <br /> ft. <br /> SPOILS —" <br /> K - e <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: atonia Y' = B <br /> s.cson <br /> Covered: ❑ Yes ❑No Y - gam pack <br /> If yes, material: <br /> , .. <br /> GROUTING or DESTRUCTION Total Depth: v2 j� tIF e. <br /> Depth to Water: — �'f n- IF <br /> n' <br /> Grout Material: <br /> Gallons of Grout Used: 140 qa,� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Ooring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 0fremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bas <br /> Thickest Thinnest aBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mi 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 7 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 1205 25 5 25 50 5 �7 � " �� <br /> 15 30 6 30 60 6 / y� <br /> 17.5 35 7 35 70 7 v <br /> 20 40 8 40 80 8 � S_ / <br /> 1 1 i7✓ s Q S l�"`� 10/16/2017 <br /> 09t,,j 4ba S <br /> 1868 E. Hazelton Avenue ockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sacehd.com <br />