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SAN JOAQUIN Environmental Health Department <br /> —COUNTY - <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:&1/ Inspector: iti -Ke--,, CONSTRUCTION <br /> Facility Address: 6.'7)L20W <br /> Well Address: 2-tlo o 3/ Total Depth: <br /> WPH Well#: 'I"8 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: eS Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: ,ok Screen Length From: To: <br /> Consultant: C.6(-j Filter Pack From: To: <br /> Geologist: G r -eip 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 /> COWLETION COMPLY•60X <br /> Holding Temperature: coMaLErION <br /> Method: ca«,ndsut.c0 — <br /> Screening Method: orari <br /> Verified Chain of Custody: ❑ Yes El No <br /> _n. <br /> n. <br /> SPOILS — <br /> Contamination Noted: ❑Yes ❑No �° = <br /> If yes,spoils storage Location: T` <br /> 4IOitDd L� = $ <br /> sscdon <br /> Covered: ❑ Yes []No _ tx-vwPack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 6u I <br /> Depth to Water: <br /> Grout Material: Ge MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: _ !`�� Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout X0ver Drill Filter Pack Type/Size: <br /> ❑ Gravity Premie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement94lb <br /> allons Bags gallons Baas <br /> Thickest Thinnest 0Bags Thickest Thinnest .Bags Bentonite/Cement Mix 3% MIX 5/ M <br /> 2.5 5 1 5 10 1 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 1 Bentonite per 94lb 2.821 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 1 7 <br /> 20 40 8 40 BO 6 <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 />