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SAN JOAQUIN <br /> Environmental Health Department <br /> —COUNTY <br /> `OacrFuaN ' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> W <br /> Date: ? OZ Ilnspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: f �L Total Depth: <br /> WP#.y I�o 14 2�i�� Well#: Drilling Rig Type: <br /> Soil Boring#: jf <br /> Drilling Company: Sy Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> s� <br /> Driller Onsite: Screen Length From: To: <br /> �' <br /> Consultant: J L r SB Z Filter Pack From: To: <br /> Geologist: InA/ Bentonite From: To: <br /> % S Sv Grout From: To: <br /> n� Public Water System Onsite: ❑ Yes ❑NoSB3 COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: CQ�5� height <br /> SAMPLING ABOVE-GROUND GHAt571,BOX <br /> Holding Temperature: S��S a�I COWFLENON COMPLETION <br /> Method: +0 25 Ground Sudac' ' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> S <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: atoned <br /> sac5on = <br /> Covered: ❑ Yes ❑No = . <br /> — 4tz,re+pxsc <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n• — ft. <br /> Grout Material: `� �QM MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> 'B Slot Size: <br /> 'Boring Installation ring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> -Gravity ) remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> pall Bags gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <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 />