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"tea $ANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> `.°^.�ieO�,:r!'' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: QCf�I�nspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: e1 Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring Min 2"Annular EHD Seal Verified: ❑Yes No <br /> Drilling company: _����� ❑ <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: jdyes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes �No casing <br /> If yes, location and distance: .� height <br /> SAMPLING ABOVE-GROUND _ <br /> Holding Temperature: <br /> COMPLEriciN COMPLETION <br /> Method: dsxtssd sudacr <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No . ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No - r <br /> — r <br /> If yes,spoils storage Location: slotwd ' <br /> 8 <br /> Covered: ❑Yes []No an »nw+P <br /> ack <br /> If yes, material: Ei <br /> GROUTING or DESTRUCTION Total Depth;—\,A!Z' c H <br /> Depth to Water: —tt ^ = . fL <br /> Grout Material: * <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Slot Size: <br /> Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 14Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> Ilons Bags eallons Bags <br /> Thickest Thinnest asags Thickest Thinnest #Bags Bentonftelcement Mix 3°/a MiX 5°/a MiX_ <br /> 25 s 5 10 1 _ Bentonite per 47lb 1A1 2.47 <br /> 5 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 is s 15 30 3 i <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 1s BB 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 an B <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 />