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SAN JOAQUIN <br /> Environmental Health Department <br /> 1°"°u'" —COUNTY <br /> lll <br /> °ql; P Greatness grows here. <br /> �Q Monitoring Well/Soil Boring Inspection Report <br /> Date: U Inspe tor: ' �`" t C" CONSTRUCTION <br /> Facility Address: o ^ <br /> Well Address: Total Depth: A c� <br /> WP# o Well#: Drilling Rig Type: <br /> Soil Boring#: H S —0 Gi SA-0 Z► qA-0 3 <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: HSA—� <br /> Driller Onsite: j Screen Length From: To: <br /> Consultant: ;c, Filter Pack From: To: <br /> Geologist: o Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑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: COMPLETION a��oN <br /> Method: Ground Staiact <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No Ili, ft. <br /> n. <br /> n. <br /> SPOILS <br /> fl, � a <br /> Contamination Noted: ❑ Yes El No <br /> 11.3- <br /> If <br /> ^ <br /> If yes,spoils storage Location: N sbtue <br /> an <br /> Covered: El Yes ❑N = g-';w Pack <br /> If yes, material: N. <br /> (� <br /> GROUTING or DESTRUCTION Total De th 60 `C • __ <br /> Depth to Water: — ( n- IF <br /> n' <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation P4oring 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 �<Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest zBags Bentonite/Cement Mix 3% Mix 5t2.47 <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 <br /> 7.5 15 3 15 30 3 A <br /> 1. 20 4 20 40 4 I !r �I +0 <br /> 12.5 25 5 25 50 5 <br /> 17.5 35 7 35 1 70 7 win 9 ��QY v N Spec �)v/ <br /> 20 40 8 40 1 80 8 <br /> 7- S � 15 S <br /> 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 />