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�°'°.USN co <br /> SAN_<J OAQ U I N Environmental Health Department <br /> o <br /> " � COUNTY <br /> �. clPi Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date ZI In ctor: 1 CONSTRUCTION I I <br /> ,(� t4 �? 4 --20 <br /> Facility Address: 2�2 i VI 2,r'' Ave 5 <br /> Well Address: 2� <br /> Total Depth: L/ft ) <br /> WP# _ Well#: Drilling Rig Type: l t "�� �0 <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: V X Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: r i 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: OONF1.EUDN c�tFnoN <br /> Method: Gmund Surf ace <br /> Screening Method: grout <br /> M VA <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stoned <br /> < = B <br /> a�e9on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: _ <br /> 7- _ <br /> GROUTING or DESTRUCTION Total'Depth: 30 =_ <br /> Depth to Water: T -ft. tt. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^' SS(�� <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> ,. <br /> Filter Pack Type/Size: <br /> El Gravity *remie ❑Other: Type of Method: <br /> Water Cemen 71b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest uBags 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 10 4 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 /> �- ' r, I S tj <' 10/16/2017 <br /> 1 E. Hazelton Avenue n California 95205 T 209 468-3420 F 209 464-0138 www.s*cehd.com <br /> 868 � I I I i <br />