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f: ( SAN JOAQUIN Environmental Health Department <br /> - ! - <br /> COUNTY <br /> F <br /> Greotnes5 grows , ^ r > . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date . zZ � Inspector : (i�r / A / CONSTRUCTION <br /> Facility Address . S Q � e Y7 <br /> Well Address : Total Depth : <br /> WP # ell # : Drilling Rig Type : <br /> Soil Boring# : Min 2 " Annular EHD Seal Verified : ❑ Yes 11 No <br /> Drilling Company : 6eejr <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : s Filter Pack From : To : <br /> Geologist :/ �/1 ' Bentonite From : To : <br /> Grout From : To : <br /> Public Water System Onsite : ❑ Yes No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No casing <br /> If yes , location and distance : height <br /> SAMPLING A 0 E-GRCiJND <br /> Holding Temperature : CCWFL.ET1ON Coca PLEmnoN <br /> Method : 4racj nd S Cauca "+ <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes ❑ No fto <br /> tt . <br /> ft. <br /> SPOILS — <br /> Contamination Noted : ❑ Yes ❑ No CD <br /> If yes , spoils storage Location : . fonmd = <br /> tocton y <br /> Covered : ❑ Yes ❑ No7'V'w Pack <br /> If yes , material : <br /> GROUTING or DESTRUCTION Total Depth : IF <br /> Depth to Water : n2 11112 <br /> Grout Material : <br /> Gallons of Grout Used : MATERIALS / DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> El Boring Installation oring Destruction Bags iz Cement : <br /> METHOD USED Bags Sand / Gravel : <br /> ❑ Pressure Grout ❑ Over Drill Type/ Brand of Bentonite : <br /> Filter Pack Type/ Size : <br /> i ravity ❑ Tremie ❑ Other : Type of Method : <br /> P�N <br /> Lo. o 6 o� ly <br /> Water Cement 471 +water Cern ent 941b <br /> gallons Bags gallons Bas <br /> Thickest Thinnest 9 Bags Thickest Thinnest b Bags Bentonite/ Cement Mix 3 % Mix 5 % Mix <br /> 2 . 5 5 1 s 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> s 10 2 10 Zo z Bentonite per 94 Ib 2082 4 . 7 <br /> 7, 5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12 . 5 1 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 S <br /> 10/ 16/ 2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464- 0138 www . s * cehd . com <br />