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SAN JOAQUIN <br />l`_---COUNTY--- <br />Greatnessgrows here. <br />%'e " 0) ori+ J- (o <br />Nd � <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Reporl <br />Date: 3 <br />'; I 2, <br />Inspector: �l1li <br />CONSTRUCTION <br />Facility A <br />dress: 1 <br />7 E ^ LC }– <br />. <br />Well Address: <br />#Bags <br />Total Depth: <br />WP# 0 <br />Well#: <br />Drilling Rig Type: <br />Soil Boring#: <br />— <br />Min 2" Annular EHD Seal Verified: <br />10 <br />Drilling Company: <br />'l <br />20 <br />Driller Onsite: <br />7.5 <br />Screen Length From: <br />Consultant: t I <br />LZ —5 <br />Filter Pack From: <br />Geologist: Lv,lt <br />Q. , <br />Bentonite From: <br />J <br />20 <br />Grout From: <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: <br />If yes, location and distance: <br />Citi■ Imwmr 1 <br />Holding Temperature:_ <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />casIng <br />height <br />ABOVE -GROUND <br />t. P • <br />%SIN% <br />Elm N <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: stoned <br />sac -Son — B <br />Covered: ❑ Yes ❑No I <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: l 16) <br />Depth to Water: No Lk goAe (• <br />Fn <br />Grout Material: � Cti�� �;Yl!,�Y �' MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: ✓t_], j Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation Paoring Destruction <br />•ArT"1 1 1 ierm <br />❑Pressure Grout ❑Over Drill <br />,Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 3% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />