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SAN JOAQUIN Environmental Health Department <br /> — COUNTY--- <br /> Greatness grows here <br /> II Monitoring Well/Soil Boring Inspection Report <br /> Date: I Inspector: CLQ CONSTRUCTION <br /> Facility Address: l�--75 R f�kwAjyt <br /> Well Address: _ Total Depth: <br /> WP# /k Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: L1 Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: t S,L. '('N,�fc�a Screen Length From: To: <br /> Consultant: � ,�� jo L Filter Pack From: To: <br /> Geologist: � � -L_�7 <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes [;�ft COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes XO —r— casing <br /> If yes, location and distance: T height <br /> i <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COrPLEnoN COMPLEnoN <br /> Method: Groans Svface <br /> Screening Method: P, grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: atoned <br /> a�cson <br /> Covered: El Yes ❑No = 9,, 4 <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_5 _ <br /> Depth to Water: ` I -fL tt. <br /> Grout Material: ti <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation .Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity *emie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas qallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 /> 10 204 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.s*cehd.com <br />