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_'0 -� SAN,,,JOAQUIN Environmental Health Department <br /> W7.�A -.-----COUNTY--- <br /> , Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: j To Inspector: �� ��., '"'�'"-CONSTRUCTION <br /> Facility Ad ress: Z� V ' F51(^X k*an <br /> Well Address: Total Depth: <br /> WP# 0 Z Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: L �, �j�r�,Mint"Annular EHD Seal Verified: L1 Yes El No <br /> Driller Onsite: 105 �'- S reen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: COMPLETION Con,tP�iEnON <br /> Method: Ground Surface <br /> Screening Method: Oran <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> n. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: •toned <br /> aeon = B <br /> Covered: ❑ Yes ❑No _ t <br /> ack <br /> If yes, material: , <br /> :Y <br /> GROUTING or DESTRUCTION Total Depth: 25 � . <br /> Depth to Water: n• — tt. <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))4Slot Size: <br /> oring Destruction r Bags Size: <br /> Cement: <br /> METHODUSED �Q���rr�C� '` i�� n � �F�) Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity IxTremie ❑Other: �— Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons I Bas eallons Bags <br /> Thickest Thinnest Thickest Thinnest nBags Bentonite/Cement Mix 3%Mix 3%Mix <br /> Z5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 25 1 50 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 35 1 70 7 <br /> 20 40 8 40 1 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.s*cehd.com <br />