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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> c46V Greatness grows here. <br /> / IeZ'OZo <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date` l 1'Ispectora <br /> : t7�+� A /"1 CONSTRUCTION <br /> Facility Address: I2 l /Y1 C L 10 <br /> Well Add re�� Total Depth: d�'"� <br /> WP# i7 L6 Well#: Drilling Rig Tyre: I <br /> Soil Boring#: —0 P T—OZ Min 2"Annular EHD Seal Verified: ❑ Yes F-1 No <br /> Drilling Company: �Q/60-:re"C <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: G 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COW�noN c�oatPt.Fnorxi <br /> Method: GroundSurtaiee + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No i---n' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted = B <br /> s.cdon r: <br /> Covered: ❑ Yes El No _ g,viW pack <br /> If yes, material: <br /> L Z 1 _ .. <br /> GROUTING or DESTRUCTION TotapDth: <br /> �� T �� J • <br /> Depth to Water: `7 — <br /> n. = n. <br /> Grout Material: -e6` <br /> Gallons of Grout Used: ^" 10MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring InstallationyBoring 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 /> ❑ Gravity remie ❑Other: Type of Method: <br /> Water / Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest ttBags 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 1 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 1 80 8 <br /> n a ( "t) bag <br /> ( 10/16/2017 <br /> 1868 E. azelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />