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2 z' SANsJOAQUIN <br /> Environmental Health Department <br /> —COUNTY <br /> oy�fr Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /' �u� Inspector: Cl ;� p „q2 CONSTRUCTION <br /> Facility Address: <br /> Well Address: ��1.`� C �o��t .n,, �Z,�oCke- Total Depth: <br /> WP#_ {7 %299H Well : Q(,f 'Z Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: AOkN�t�yl,�(,va 1��,, � .� Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> TS Screen Length From: To: <br /> Driller Onsite:Xa <br /> Consultant: �y Filter Pack From: To: <br /> Geologist: 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 casing <br /> If yes, location and distance: height <br /> SAMPLING Asove-GRourto <br /> Holding Temperature: COWPLETION �tFrtoN <br /> Method: Ground Surfa * <br /> Screening Method: crop <br /> Verified Chain of Custody: ❑ Yes ❑No �ft• <br /> n. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted = E <br /> aKson ' = B <br /> Covered: ❑ Yes ❑No <br /> — prava pads <br /> If yes, material: ir! <br /> GROUTING or DESTRUCTION Total Depth:�7 . <br /> Depth to Water: 2F —GroutMaterial: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation '(�IWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags 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: a�` Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bags Pallons Bags <br /> Thickest Thinnest rlBags Thickest Thinnest pBags 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 2Bentonite 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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />