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y. SAN�JOAQUIN <br /> f� r _` Environmental Health Department <br /> COUNTY <br /> Greotness grows fere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ZJ` pins ector: SU v e;t CONSTRUCTION <br /> Facility Address: 17 A�Z r �e JSI,L <br /> Well Address: Total Depth. 77(d <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: V(es ❑No <br /> Drilling Company: 7W1� <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To:�_ <br /> Geologist: Bentonite From: To: 0 <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 ASOYE-GROUND —9 <br /> COWPLETION COMPLEnOX <br /> Holding Temperature: cOMPI.E7iON <br /> Method: Girovnd Surfac* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft. <br /> ft. <br /> SPOILS J <br /> Contamination Noted: ❑ Yes ❑No _ 4 <br /> If yes,spoils storage Location: <br /> tac�on <br /> Covered: El Yes ElNo .= 9- Pack <br /> If yes, material: <br /> GROUTING-or-DESTRUCTION Total Depth:- <br /> Depth to Water: n' <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 /> ❑Boring Installation ❑Boring 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 /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water T <br /> allons Bas allons Thickest Thinnest ttBags Thickest Thinnest BentoniteXement Mix 3% Mix 5% MIX <br /> 2.5 5 1 s 10 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 <br /> 10 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />