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SAN JOAQUIN Environmentar riealth Department <br /> COUNTY— <br /> Grealness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7— Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP#z3o ag7,0"1{ Well#: Drilling Rig Type: <br /> Soil Boring#: h�P�of Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Ce,o <br /> D Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: r ii� Filter Pack From: To: <br /> Geologist: a.et µW - Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No ageing <br /> If yes, location and distance: � height <br /> GG <br /> SAMPLING Aeove-GROUNo CHAt r-Box <br /> Holding Temperature: COWLETION COMPLETION <br /> Method: Ground uixe —F — <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Non' <br /> n. <br /> SPOILS _ <br /> _ � o <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: eb <br /> section 4 <br /> Covered: ❑ Yes ❑No L., <br /> 3 _ g-,Wpack <br /> If yes, material: e <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 30 <br /> Grout Material: M/ufrewy+ 't" MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: /5 9 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ,��// Slot Size: <br /> ❑Boring Installation LhBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout <br /> �Dover Drill Filter Pack Type/Size: <br /> ❑ Gravity Ls7Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Ba s allons Bags <br /> Thickest thinnest Reags Thickest Thinnest Ai Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.s s i 5 10 1 Bentonite per47lb 1.41 2.47 <br /> s l0 2 10 20 2 Bentonite per 941b 2.82 4.7 <br /> 7.5 15 3 1s 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> i5 30 6 30 60 6 <br /> 17.5 35 1 7 35 70 7 <br /> 20 40 0 40 00 3 <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 />