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°" r SAN�JOAQUIN <br /> �. Environmental Health Department <br /> COUNTY— <br /> �`�, "-/ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> 2 <br /> Date: � Inspector: 01, ' f�l.Gt-5 CONSTRUCTION <br /> Facility Address: f , <br /> Well Address: - - - - - ---- - - 1 Total Depth:- <br /> WP# �n� Z Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: (faCDVI Min 2"Annular EHD Seal Verified: El Yes []No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: l o Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes EJ No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COV��N COMPLE'nON <br /> t" <br /> Method: G=ndSurface + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —`--n' <br /> tt. <br /> ft. <br /> SPOILS ; <br /> _ e <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: sbnad <br /> a�c7on — B <br /> Covered: ❑ Yes ❑No = gmvl+Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: = IF_ <br /> Depth to Water: b n n' <br /> Grout Material: <br /> Gallons of Grout Used: �' MATERIALS/DEVELOPMENT <br /> �vj�V 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 /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest 1t 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 V 15 30 3 <br /> 10 20 4 ✓ 20 40 4 <br /> 125 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 /> Q 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s4cehd.com <br />