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" 2 SANsJOAQUIN <br /> Environmental Health Department <br /> ` —COUNTY— <br /> °4, P' Greatness grows here Z <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2� Inspecto ::' CONSTRUCTION <br /> ddr <br /> Facility Aess: Z 5: wzw� we. <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: L1 Yes El No <br /> Driller Onsite: - Screen Length From: To: <br /> Consultant: f Filter Pack From: To: <br /> Geologist: oxu eAcL 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING Asov>:-caanvo <br /> C <br /> Holding Temperature: COkFLETN C <br /> 10OMPtEncN <br /> Method: G=nd Surface <br /> Screening Method: Oran <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> If yes,spoils storage Location: slotted <br /> sacion s <br /> Covered: ❑ Yes ❑No <br /> g-vw Pack <br /> If yes, material: \> <br /> GROUTING or DESTRUCTION Total Depth:, _— <br /> Depth to Water: V . <br /> Grout Material: <br /> Gallons of Grout Used:"I ^. 1,01106 � MATERIALS/DEVELOPMENT <br /> jrJ Casing Type: <br /> ❑Well Installation DA ell estruction Blank Feet Screen Feet <br /> I Slot Size: <br /> ❑Boring Installation XBoring Destruction ak Bags of Cement: <br /> METHOD USED 2 ^� OQI� Bags Sand/Gravel: <br /> Pressure Grout ❑Over Drill �(` Type/Brand of Bentonite: <br /> ❑ <br /> `� Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ent 471" Water Cement 941b <br /> allons I Bas gaill ons Bags <br /> Thickest Thinnest #Bags_ Thickest Thinnest "Bags Bentonite/Gement 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 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 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />