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SAN�JOAQUIN <br /> � Environmental Health Department <br /> COUNTY— <br /> r,4�r/ Greotness grows here. <br /> /,�// l Monitoring/+Well/Soil Boring Inspection Report <br /> Date:k%/19 Inspector: (v CONSTRUCTION <br /> Facility Address: �� / <br /> Well Address: 1 z-( e C(gu/ i_ Total Depth:_�- f <br /> WP# ®o `�10i Well#: Drilling Rig Type: l <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: .cJu\e�-L <br /> Driller Onsite:—M9�6 � g\�U�'Q. Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <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: im height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: Cot tPLETtoN �LEnoN <br /> Method: Ground Surfac* <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted ' <br /> aeon �- — <br /> B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: j �_ •. <br /> Depth to Water: <br /> Grout Material: L�M&41� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring 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 4Tremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest i7 Bags 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 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 /> 9,_\ N�f 10/16/2017 <br /> 1868 E. Hazelton Avenue I S#ockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />