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- c SANJOAQUIN <br /> Environmental Health Department <br /> ) —COUNTY— <br /> ��GFoa P/ Grectness grows here. <br /> (' Monitoring Well/Soil Boring Inspection Report <br /> Date: ?�I I1I `14 U� Inspector: CONSTRUCTION <br /> Facility Address: ��jV� <br /> Well Address: \\1\ M( Total Depth: <br /> WP# �c` kpLlinb-. Well#: Drilling Rig Type: �y� <br /> Soil Boring#: a �Ik <br /> Company: Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling p y: All l,',-bi al��.r,I p rw�� Screen Length From: To: <br /> Driller Onsite: e -1 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 El No casing <br /> If yes, location and distance: height <br /> ++ T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLET10N CoMP�LEnON <br /> Method: around Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —`—'n' <br /> it. <br /> it. <br /> SPOILS <br /> a <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> s.cJon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: .y <br /> Depth to Water: tt. ft. <br /> Grout Material: �C (�; Q�. �r k <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 4Bags 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 1 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 1 40 8 1 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />