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'C paa'" SAN JOAQUIN <br /> � Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2�i Inspector: 1\ CONSTRUCTION <br /> Facility Address: GU(((il r. <br /> Well Address: �ov�ti�Ain Total Depth: – <br /> WP#ON 1S_Tq Well#: Drilling Rig Type: <br /> Soil Boring#: CIP T__ I Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: _ <br /> Driller Onsite: �,n J Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: BS IL P650c: cu ?_5 <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑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: CONPLETZN COMPLETION <br /> Method: Grund Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abnnd <br /> soc:cn <br /> Covered: ❑ Yes 11 No = �, <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> r — <br /> Depth to Water: C n. <br /> tt <br /> Grout Material: ' <br /> Gallons of Grout Used: Ili GU.\IU'1\S MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction ��(`� � Blank Feet Screen Feet <br /> �� Slot Size: <br /> ❑Boring Installation EI.Boring Destruction 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 MTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest aBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s V, 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10z V 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 3060 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.secehd.com <br />