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SAN . J OAQ U I N Environmental Health Department <br /> - COUNTY <br /> Greatness grows herr . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : Inspector : Vv' f CONSTRUCTION <br /> Facility Address . <br /> Well Address : 10 4r Total Depth : 7� _ <br /> WP # (A) We # : Drilling Rig Type . <br /> Soil Boring# : <br /> Drilling Company : ilr� Min 2 " Annular EHD Seal Verified : El Yes ❑ No <br /> Driller Onsite : c, Screen Length From : To : <br /> Consultant : Filter Pack From : To : <br /> Geologist : % � ,�,w1( � 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 /> T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature : COMPLETIONCOMPLEMN <br /> Method : t3=nd Surf=* "'~ <br /> Screening Method . grout <br /> Verified Chain of Custody : ❑ Yes ❑ No n' <br /> ft. <br /> AL <br /> ft. <br /> SPOILS . <br /> Contamination Noted : ❑ Yes ❑ No <br /> If yes , spoils storage Location : sbtxQd "— <br /> w _ <br /> Covered : ❑ Yes ❑ No <br /> Qra,rsi Pack <br /> If yes , material : <br /> GROUTING or DESTRUCTION Total Dept64MATERIALS/ DEVELOPM <br /> I <br /> Depth to Water : <br /> Grout Material : <br /> ENT <br /> Gallons of Grout Used : d 4 LAI � Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> 4 <br /> Boring Installation ❑ Boring Destruction Bags of Cement : <br /> METHOD USED Bags Sand / Gravel : <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill Filter Pack Type/Size : <br /> ElGravity )44 <br /> emie ❑ Other : Type of Method . <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izallons Bags <br /> Thickest Thinnest # Bags Thickest Thinnest riBags Bentonite/Gement Mix 3 % Mix 5 % Mix <br /> 2 . 5 s 1 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2 . 82 4 . 7 <br /> 7. 5 15 3 15 30 3 <br /> 10 1 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 Stockton , California 95205 T 209 468 - 3420 F 209 464- 0138 www . smcehd . com <br />