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SANs�JOJOAQUIN <br /> (NU J SANQ Environmental Health Department <br /> �✓ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: '�C' Inspector: f(GnC,f(o Imo,L CONSTRUCTION <br /> Facility Address:(rzP%,yb P ,a r 0, C1 s <br /> Well Address: Total Depth: <br /> WP# d0� C) Well#: Drilling Rig Type: f <br /> Soil Boring#: S(A— � Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: ti';, 5 Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: <br /> 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: T height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLEMN COMP�LE'nON <br /> Method: °round Surface <br /> Screening Method: R ar«n <br /> Verified Chain of Custody: ❑ Yes El No -tt• <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: abed <br /> sacyon — B <br /> Covered: ❑ Yes ❑No = vel pack <br /> If yes, material: r <br /> GROUTING or DESTRUCTION Total Depth: 1S <br /> Depth to Water: tt. u <br /> IFtt. <br /> Grout Material: � <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation XBoring 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 r�Tremie ❑Other: Type of Method: <br /> Water Cemeil <br /> Water Cement 941b <br /> gall ons allons Bags <br /> Thickest Thinnest 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 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 /> 186 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br />