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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> ess gr°ws here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 05jg1Z4 Inspector: Skfias CONSTRUCTION <br /> Facility Address: N5'F <br /> Well Address: Total Depth: <br /> WP# 11)�Q(�cl`5�(� Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company:C rim("L' <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: S)i-Pp)d.V�Povil1 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 casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> COMPLETION GMSTY-eOX <br /> Holding Temperature: cornrt.EnoN <br /> Method: Groundsuiacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ONO �ft. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes []No <br /> If yes,spoils storage Location: ' <br /> :ecdo _ B <br /> a4o5on <br /> Covered: ❑ Yes ONO <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: to <br /> Depth to Water: <br /> Grout Material: cehnwMATERIALS DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation KBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Cover Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water merit 47lb Water Cement 94lb <br /> allons Ba s 10 eallens Boo <br /> Thickest Thinnest #ea Thickest Thinnest ABags BentonitelCement Mix 3% MIX 5%MIX <br /> 2.5 s 1 s 10 1 Bentonite er471b 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94lb 1 2.821 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 /> is 30 6 30 60 6 <br /> 17.5 35 7 11 35 70 7 <br /> 20 40 81 0 80 a <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 />