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z —U,-- <br /> SAN JOAQUIN Environmental Health Department <br /> Olt; --COUNTY- <br /> ``Q�r,Fo ¢J Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: f0��1 Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# 1 V Well#: Drilling Rig Type: <br /> Soil Boring#: TG Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: h Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: OOWPLEn°N a�tEnON <br /> Method: GroundSurfaas <br /> Screening Method: arocri <br /> Verified Chain of Custody: ❑ Yes F-1 No -�—n' <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: <br /> axion < — <br /> Covered: ❑ Yes ❑No _ Q-vw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTIO Total Depth: <br /> Depth to Water: n n' <br /> Grout Material: �e(.d uta/ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: I►A, <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity []Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> Rall s Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest aBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 s 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 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />