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SAN_J0A0UIN Environmental Health Department <br /> —COUNTY <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: <br /> 5 ��7l <br /> Inspector: a CONSTRUCTION <br /> Facility Address:_c�o` S 4. <br /> Well Address: 4, 5. Total Depth: <br /> WP# O0%g l Well#: —O�4 Drilling Rig Type: J jT <br /> Soil Boring#: 5 & O Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: I, G <br /> D ; ( Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: 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: COWLETION ccmPLEnoN <br /> Method: G=ndSwfacn T <br /> Screening Method: air«n <br /> Verified Chain of Custody: ❑ Yes ❑No Ir ft. <br /> ft. <br /> ft. <br /> SPOILS a = <br /> Contamination Noted: ❑ Yes El No =" <br /> If yes,spoils storage Location: abnod <br /> Covered: ❑ Yes ❑No <br /> If yes, material: 4, <br /> GROUTING or DESTRUCTION Total Depth: "IS- P 4. ___ <br /> Depth to Water: _fL n' <br /> Grout Material: C.P//n <br /> Gallons of Grout Used: �-3 6 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation VWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure GroutOver Drill <br /> �� Filter Pack Type/Size: <br /> El Gravity `�Trem�ie Other: Type of Method: <br /> Water Ceme 471b Water Cement 941b <br /> gall Ba s allons Bags <br /> Thickest Thinnest 1tBags Thickest Thinnest VBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 /> 17.5 35 7 35 70 7 <br /> 20 4 8 40 80 8 <br /> "?Sa y� 6 q �a S 10/16/2017 <br /> 1868 E. Hazelton Avenue St ckton, California 95205 T 209 468-3420 1 F 209 464-0138 www.s*cehd.com <br />