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• cuiN ' <br /> f? SAN JOAQUIN <br /> _ Environmental Health Department <br /> l� COUNTY— <br /> °' yr Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ; c Inspector: , /)'1 VOr CONSTRUCTION <br /> Facility Address: 11��_ r'r ( a, e <br /> Well Address: h Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Pe-ne-core <br /> C76-I?, <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: �1 Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GRCXJND <br /> Holding Temperature: COWLEMN COMPLETION <br /> Method: around Surface <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> — m <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: <br /> sacton — <br /> Covered: ❑ Yes ❑No = s <br /> If yes, material: =k <br /> GROUTING or DESTRUCTION Total Depth: =_ <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> )qremie <br /> Filter Pack Type/Size: <br /> ElGravity ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bags eallons Bags <br /> Thickest Thinnest 1:Bags Thickest Thinnest kBags 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 /> 75 15 3 15 30 3 <br /> 10 10 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 />