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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: V Inspector: vas, CONSTRUCTION <br /> Facility Ad ess. <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: a 1 <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: 0 tlolcje <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 4�"ffl_n Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: height T. <br /> SAMPLING ABOVEGROUND T <br /> COMPLETION CPO <br /> Holding Temperature: COMPLETION <br /> Method: Grounds Io" 7_ <br /> Screening Method: groin <br /> Verified Chain of Custody: ❑ Yes ❑No It. <br /> n. <br /> —ft. <br /> SPOILS k e <br /> Contamination Noted: ❑ Yes ONO � =_ <br /> If yes,spoils storage Location: ' <br /> alonad <br /> aac5on .I _ . <br /> Covered: ❑ Yes ONO gnsValpeck <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:�� <br /> Depth to Water: n. <br /> Grout Material: 1wP MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 'l- Casing Type: <br /> ❑Well Installation �6well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> 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 remie ❑Other: Type of Method: <br /> Water _ ea Ce ent 471 Water Cement941b <br /> allons s gallons Bags _ <br /> Thtd:est Thinnest ags Thld<est Thinnest #Bogs _ Bentonite/Cement Mlx 3% Mix 5%MIX <br /> 2.5 5 1 s 10 1 Bentonite per 47 lb 1 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 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 i80 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.s4cehd.com <br />