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SAN ,JOAQUIN Environmental Health Department <br /> cq. <br /> (r <br /> t" t —COUNTY— <br /> \ <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: ^' CONSTRUCTION <br /> Facility Address: MuS� <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: � Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 61- Filter Pack From: To: <br /> Geologist: A'rF 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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: tbWLE7toN c1FnoN <br /> Method: Ground surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �--n• <br /> n. <br /> n. <br /> SPOILS <br /> = e <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: won" <br /> eacdon <br /> Covered: ❑ Yes ❑No <br /> 9-1101 Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: - __ <br /> Depth to Water: 1 i—� n• n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: r I <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction I� I Blank Feet Screen Feet <br /> 2, d t Slot Size: <br /> ❑Boring Installation ]Boring Destruction Bags of Cement: <br /> METHOD USED �/ �v Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill ��� <br /> Filter Pack Type/Size: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest Al Bags Bentonite/Cement Mix 3% Mix 3%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 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 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 209 468-34201 F 209 464-0138 1 www.s*cehd.com <br />