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f,rau'"cSAN�JOAQUIN <br /> Environmental Health Department <br /> #� U 1i <br /> � .� ` —COUNTY-- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: (u Z Inspector: CONSTRUCTION <br /> Facility Address: It L '' Z'�� <br /> Well Address: _ t}f\WN,Wjk Total Depth: <br /> WP# % Well#: Drilling Rig Type: <br /> Soil Boring#: Iti Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: c;(cJkgo () <br /> Driller Onsite: 0 Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: tjvlC <br /> 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 /> _CWT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: corP�noN �LEneN <br /> Method: Gmne Surfacs <br /> Screening Method: ofOcA <br /> Verified Chain of Custody: ❑ Yes ❑No �R. <br /> n. <br /> ft. <br /> SPOILS a <br /> Contamination Noted: ❑ Yes EJ No <br /> If yes, spoils storage Location: <br /> slotted .— B <br /> ► .on <br /> Covered: ❑ Yes El No = g,,,wPack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 5 act . <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation I(Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest bBags 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 15 30 3 <br /> 10 204 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 www.s6cehd.com <br />