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SAN 10AQUIN <br /> tt ` Environmental Health Department <br /> IN fey j — COUNTY <br /> r ' `c�ciF°aNP' Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : 12 I A Inspector: 1r" CONSTRUCTION <br /> Facility Address : � , w i <.,,on. UM <br /> Well Address : Total Depth : <br /> rrW <br /> WP# Z Well # : Drilling Rig Type : <br /> Soil Boring# : 1 Min 2" Annular EHD Seal Verified : ❑ Yes [] No <br /> Drilling Compan \ S <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : yu 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 /> �qw" <br /> SAMPLINGABOVE-G ROUND <br /> Holding Temperature : COWFLET{ON COOMPt. CN <br /> Method : Ground Surface Af <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes El No � tt' <br /> tt. <br /> ft. <br /> SPOILS = <br /> Contamination Noted : ❑ Yes ❑ No <br /> If yes, spoils storage Location : stod -= <br /> sacqon — <br /> Covered : ❑ Yes ❑ No <br /> vivo, Pack <br /> If yes, material : I' <br /> GROUTING or DESTRUCTION Total Depth : <br /> Depth to Water : <br /> Grout Material : MATERIALS/ DEVELOPMENT <br /> Gallons of Grout Used : <br /> Casing Type : <br /> ❑ Well Installation �'KWell Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation ❑ Boring Destruction Bags of Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> v�. Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill <br /> Filter Pack Type/Size : <br /> ' Gravity ❑ Tremie ❑ Other : Type of Method : <br /> ✓ Water ment 471 Water Cement 941b <br /> allons siRzalll ons Bags <br /> Thickest Thinnest # Bags Thickest Thinnest # Bags Bentonite/Gement Mix 3 % MIX 5 % MIX <br /> 1. 5 5 1 - 5 10 1 Bentonite per 47 Ib 18411 2 .47 <br /> 5 10 1 10 20 2 Bentonite per 94 Ib 26821 4 .7 <br /> 7. 5 15 3 15 30 3 <br /> 10 20 10� 4 20 40 4 <br /> 12. 5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17. 5 35 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 . sjcehd . com <br />