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� OVIry <br /> SANsJOAQUIN <br /> .,�•;, ; Environmental Health Department <br /> —COUNTY <br /> Greatness grozis here. <br /> "9[IFOIRP <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ins_ector: '�_36L CONSTRUCTION <br /> Facility Address: 2 G 1 <br /> Well Address: Total Depth: t <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: 1 M*n 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> '✓Drilling Company: ty t✓t?pl kt,etq j -,, <br /> Driller Onsite: Green Length From: 'i8 To: �$ <br /> Consultant: N`r Filter Pack From: 6S To: <br /> Bentonite From: S IZ To: 6 <br /> Geologist: �5 <br /> Grout From:4O ' r To: S <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes,location and distance: height <br /> SAMPLING heave GaouNo <br /> COMPLETION COMPLEMOx <br /> Holding Temperature: coMPt.ErtoN I <br /> Method: Oround s viac4 <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> Covered: ❑Yes ❑No on I = QMVw Pack <br /> If yes,material: QM <br /> GROUTING or DESTRUCTION Total Depth: O ct` <br /> Depth to Water: /�� n• <br /> Grout Material: N?t 1QIMQ.(/l MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type:_ <br /> ❑Well Installation ❑Well Destruction . g4ank eet Screen 10t Feet <br /> of Size: <br /> ❑Boring Installation ❑Boring Destruction � Bags of Cement: <br /> METHOD USED �p/�y� �"a!I Bags Sand/Gravel: balm <br /> ❑Pressure Grout ❑Over Drill b��� Type/Brand of Bentonite: 'urw CGK') <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑T ❑other: jb Type of Method: 40 �o w S+OVL <br /> Water ment4716 Water Cement941b 1 J <br /> allonz F Basts alions Ba s <br /> Thickest Thinnest egs Thickest Thinnest bBags Bentonitelcement Mix 3%MI %Mix <br /> 15 5 1 5 10 1 _ Bentonite per 47 lb 11 1.4 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.8 4.7 <br /> 7.5 15 3 15 30 3 -, <br /> 30 20 4 20 40 4 <br /> 115 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 15 20 40 8 40 30 8 "1 • �•� ��/ <br /> 10/16/2017 <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.smcehd.com <br />