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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> lore -i � ,�� <br /> Date: 3JUJIIElJ5 Inspector: CONSTRUCTION C011 UarOV, pat"s _ 4 <br /> Facility Address: Uyoh ( h� ( �� <br /> Well Address: .f MY Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> `(/Yt,li �� Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: I ( Screen Length From: To: <br /> Consultant: N n66 Filter Pack From: To: <br /> Geologist: <br /> Bentonite From:Z.� To: 3.5' <br /> �QY��h f C �e <br /> Grout From: 2.6 To:— (V <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 /> r <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: COMPLEMON CCXW=CN <br /> Method: Ground Surf aca <br /> Screening Method: grout 2 .5 �� � 9u� <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: El Yes El No = 1 t <br /> If yes, spoils storage Location: slo _ � ' <br /> Bacon <br /> Covered: ❑ Yes ❑No = 7xv-101 Pack <br /> If yes, material: . <br /> GROUTING or DESTRUCTION Total Depth: Y <br /> Depth to Water: n• <br /> Grout Material: C � r MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: � j 1 � Casing Type: <br /> foil vap� g Yp <br /> ell Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation7�Boring Destruction Slot Size: <br /> 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 `FzTremie ❑Other: Type of Method: <br /> Water / Cement 47lb Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 1205 25 5 25 50 5 So <br /> 15 30 6 30 60 6 J <br /> 1205 40 8 40 80 aZ6, , , 2 3 <br /> S� G 2'3 w ref- n 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 Jwww.secehd.com <br />