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SAN JOAQUIN Environmental Health Department <br /> — <br /> COUNTY -- <br /> \FiJPoa?`! Greatness grows here. <br /> Mo <br /> nitoring eWell/Soil Boring Inspection Report <br /> Date: Inspector: 7'• CONSTRUCTION <br /> Facility Address: «.l (,2 <br /> Well Address: Total Depth: c / if <br /> WP# Well#: Drilling Rig Type: J t7 <br /> Soil Boring#: T — 131 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 77A a c b h <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: r�S o 2Ail— Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes EJ No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND _ <br /> Holding Temperature: COWLETION COMPLE ON <br /> Method: Ground Surtax <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes []No <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No ` <br /> If yes, spoils storage Location: slotted <br /> soon <br /> Covered: El Yes ❑No _ g-vW pack <br /> If yes, material: II <br /> GROUTING or DESTRUCTION Total Depth: <br /> T CX �) =_ <br /> Depth to Water: kip k_LP__ n- n• <br /> Grout Material: Vt*' <br /> r` MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation$Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ,KGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Bag gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5%MIX <br /> 1.5 s 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 1 2.821 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 /> 10 40 840 80 8 <br /> 2S 10/16/2017 <br /> 18681 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />