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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 61120121 Inspector: 'h CONSTRUCTION <br /> Facility Address: 2 <br /> Well Address: n • Total Depth: <br /> WP# Ulla Well#: Drilling Rig Type: <br /> Soil Boring#: _ <br /> Drilling Company: 14 67.61 n f'155oC,'t e S Tric. Min 2"Annular EHD Seal Verified: El Yes 11 No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: IC.I 7'an Filter Pack From: To: <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: Ing <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COLPLE N COMPLEnoN <br /> fO <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> it. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes []No — <br /> If yes,spoils storage Location: slotted s <br /> sac-son — B <br /> Covered: ❑ Yes ❑No = VW <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: __ <br /> Depth to Water: W 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 /> Slot Size: <br /> El Boring Installation P48oring Destruction Bags of Cement: <br /> METHOD USED ,?�-�g� ` Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bags eallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 r 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 5 25 50 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 7 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 />