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SAN'JOAQUIN Environmental Health Department <br /> �h " —COUNTY- <br /> 9cP,� Greatness grows Frere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: f_ L I Inspector: CONSTRUCTION <br /> Facility Address: t'.i i <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: D t n 1 <br /> f�� � Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: w <br /> Driller Onsite: L Vi.v Screen Length From: To:Filter Pack From: To: <br /> Consultant: 1,r7�fP/� <br /> Geologist:' yL f1 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ,[�'No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes Z No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND CHR__ <br /> Holding Temperature: COWPLET10N CCMPLETION <br /> Method: Gmne Surface <br /> Screening Method: 971, praut <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No ;. <br /> If yes, spoils storage Location: sbtwd <br /> sac�an <br /> Covered: ❑ Yes ❑No _ Pack <br /> If yes, material: <br /> gr"f <br /> GROUTING or DESTRUCTION Total Depth: u __ _V _- <br /> Depth to Water: J ` n' <br /> Grout Material: ,lit ( thM�t <br /> Gallons of Grout Used: 55 11e4 �W L 7 I»s"�� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ,� Type of Method: <br /> Gravity %Tremle ❑Other: 2 <br /> k���bu� � L���tl� �ti� iv• t C�`f°�" � <br /> Water Cement 471 Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnestags Thickest Thinnest 4Bags 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 A 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 40 4 � <br /> 12.5 5 25 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 35 70 7 <br /> 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s4cehd.com <br />