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f°­�c� SAN JOAQUIN <br /> '2 Environmental Health Department <br /> .1 —COUNTY— <br /> C' <br /> r/ Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1Z Inspector:_ CONSTRUCTION <br /> Facility Ad ress: <br /> Well Address: _ _ _ _ _ Total Depth: <br /> WP#.7U� l cid{ I Well#: Drilling Rig Type: <br /> Soil Boring#: C7 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: �2r(C+.(_OYl <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: , (,�� L �Er_ 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: WT <br /> height <br /> SAMPLING ABOVE-GRCXJND <br /> Holding Temperature: 00&PLEMN cmptEnoN <br /> o <br /> Method: Ground Svhct <br /> Screening Method: orot t <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS : <br /> - - o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> aw <br /> &action <br /> s <br /> Covered: El Yes ❑No �4"� _ g,,,w <br /> PaCK <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 10c, -ft ft. <br /> Grout Material: �LC�� C�.YV�PV�fi <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: \l�q( Qi�oy�• <br /> 2 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installationj&Boring Destruction CQ,Y*(tk Bags of Cement: <br /> METHOD USED vi K� Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill � ` g <br /> X Filter Pack Type/Size: <br /> 5,Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest sBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 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 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 209468-34201 F 209464-0138 1 www.s*cehd.com <br />