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SAWIJOAQUIN Environmental Health Department <br /> COUNTY----... <br /> �gc+ P•' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 Inspector:I�A'Visfo tia. ;z CONSTRUCTION <br /> Facility Address: <br /> Well Address: (W 1L O-gl 4j, Total Depth:_1'P <br /> WP# ©0 Lfl 0,16 Z Well#: Drilling Rig Type: <br /> Soil Boring#: S ti'O, <br /> Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: (y$ Cab: o <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 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 AWVE-GROUND <br /> Holding Temperature: CONFLETION CIPtEnON <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �---n' <br /> n. <br /> tt. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> sac.on — B <br /> Covered: ❑ Yes ❑No _ gravel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: li) IFIF <br /> Depth to Water: n• W n- <br /> Grout Material: J�Jiw� C e-_,,.A,n` MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> []Well Installation . Well Destruction Blank Feet Screen Feet <br /> El 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 K]Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest #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 3130 60 6 <br /> 17.5 35 35 70 7 <br /> 20 40 8 40 80 8 <br /> q'\ �0 " 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />