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SWJOAQUIN Environmental Health Department <br /> COUNTY­ <br /> Greatness <br /> Greatness grows here. <br /> Monitak. <br /> oring Well/Soil Boring Inspection Report <br /> Date I Inspector: CONSTRUCTION <br /> Facilit Address: 40 11 . <br /> Well Address: Total Depth: <br /> WP# L4 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes 11 No <br /> Driller Onsite: t Screen Length From: To: <br /> Consultant: ti C0E � 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: COWPLETION cru nccN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �---n' <br /> n. <br /> n. <br /> SPOILS <br /> ya = V <br /> Contamination Noted: ❑ Yes ❑No = <br /> c <br /> If yes, spoils storage Location: sbned = - <br /> secZon <br /> Covered: ❑ Yes ❑No <br /> gra Pack <br /> If yes, material: <br /> �- <br /> GROUTING or DESTRUCTION Total Depth J 1 5 <br /> Depth to Water: fit) � �l G�V- � t n• n' <br /> Grout Material: C�eV' j <br /> Gallons of Grout Used: 1 C lJ � MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Poring Destruction's Lj o Bags of Cement: <br /> METHOD USED '2_ a Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> El Pressure Grout ver Drill U� <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b , Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest kgs 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 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com <br />