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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> MonitoringdWell/Soil Boring Inspection Report <br /> Date: Inspector: IY✓7 0 `1 CONSTRUCTION <br /> Facility Address: 2 30 C' rre <br /> Well Address: Total Depth: <br /> WP# 7s _Well#: S L I � Drilling Rig Type: <br /> Soil Boring#: DO 3 9 7 D Min 2"Annular EHD Seal Verified: ❑ Yes El NO <br /> Drilling Company: C'e?-fc.o—j& Screen Length From: To: <br /> Driller Onsite: 24 Filter Pack From: To: <br /> Consultant: �1. - ��r� Bentonite From: To: <br /> Geologist: Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No oaring <br /> height <br /> If yes,location and distance: <br /> SAMPLING ABOVE-6 4 0 crwlsrreox <br /> oowLETION COMPLETION <br /> Holding Temperature: around s rhos --�_• <br /> Method: grout <br /> Screening Method: I <br /> Verified Chain of Custody: ❑Yes ❑No n. <br /> SPOILS o <br /> Contamination Noted: ElYes ❑No V <br /> If yes,spoils storage Location: awwdT' <br /> ssclon <br /> Covered: ❑ Yes ❑No 9ack <br /> If yes, material: ./ H <br /> GROUTING or DESTRUCTION Total Depth: " �' 6 I <br /> Depth to Water:— <br /> Grout Material: C �iK MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 4�) Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ID <br /> El Boring Installation El Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: <br /> Type of Method: <br /> Water Cement 471b Water cement 941b <br /> allons Be s allons Be s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.s s 1 5 <br /> 10 1 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 lBentonite er 941b <br /> 7.5 15 3 15 30 34 <br /> 10 20 4 20 40 <br /> 12.5 75 5 25 so 5 <br /> Is 30 6 30 60 6 <br /> 17.5 1 35 11 35 70 7 <br /> xo 4o a 40 so B 10/16/2017 <br /> , b <br /> 1868 E. Hazelton Avenue I St ckton, California 952051 T 209 468-3420 F 209 464-0138 www.s6cehd.com <br />