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Ocxrw-*X( .in dci <br /> 'o�auiy'r,. 1 t 1j 'tiOr l. <br /> � -� SAN-JOAQUIN ,�'.L3 <br /> rr Environ'rrie tai Health Department <br /> l\� COUNTY �p.L'�' I�l# �a .ts.i+�} 10nni^ dNili2jo,d PQvw.if Fjvvt�tZlv�l <br /> Greatness grows heir. J <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I2Q Inspector: CONSTRUCTION <br /> Facility Address: fffj �'+, Lc c� I <br /> Well Address: Total Depth:. <br /> WP# 0 n�1 S - Well#: - - - Drilling Rig Type: <br /> Soil Boring#: Ox Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Ti .t ca_wh <br /> Driller Onsite:� Screen Length From: To: <br /> Consultant: T?,Y Gk(•u). Filter Pack From: To: <br /> Geologist: �0—t-66t- SCI\P.Ir• _ 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWFLErION co pt-EnoN <br /> Method: G=ndSurfw* T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS u <br /> = o <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: atottod <br /> sac�on r <br /> Covered: ❑ Yes ❑No = g,,,'WPack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: :ui <br /> Depth to Water: ` tt• n' <br /> Grout Material: ,!a>'N Qj,OVO <br /> Gallons of Grout Used: I LI qm C� we MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction yl\b � Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation [Boring Destruction WQ Y <br /> q,� �� Bags of Cement: <br /> METHOD USED � Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> [RGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 9Bags 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 v 10 2 ✓ 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> cl 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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com <br />