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% SANsJOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> ra�,r <br /> °"uFoaP Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �� i11?"� Inspector: wr(, W (.��Qu^��, CONSTRUCTION <br /> Facility Address: <br /> Well Address: _1\35 5'`- 14o, QV�N Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: r Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: 1,� �oe ��nrz, o� Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 6urce 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: COWPLErION cc6un-EnciN <br /> Method: Ground Surtacrr <br /> Screening Method: ori <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> n. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: slotted <br /> ser3on = B <br /> Covered: ❑ Yes ❑No = vel <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: y <br /> Depth to Water: fL –ft. <br /> GroutMaterial: N a ,.1 1; „� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation pBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> p Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: �r�tL 1�titi�, Type of Method: <br /> Water Cement 471b Water Cement 94Ib <br /> allons Bags gallons Bags <br /> Thickest Thinnest »Bags Thickest Thinnest RBags 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 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 209 468-3420 1 F 209 464-0138 1 www.sacehd.com <br />