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°P�U'"r°GZ� SAN�JOAQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness"°�t,Foar1P' grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: qhUlAX Inspector: S R),q M�,W VM �, ONSTRUCTION <br /> Facility Address: (a ID N 1U�'1 <br /> i <br /> Well Address: Total Depth: <br /> WP# 260 , I Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: El Yes []No <br /> Driller Onsite: q.��t? Screen Length From: To: <br /> Consultant:�'iG( Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: 111 <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION Ca Pt.F ON r <br /> Method: GroundSurlacs T <br /> Screening Method: Ft M grout <br /> Verified Chain of Custody: ❑ Yes El No �ft• <br /> ft. <br /> ft. <br /> SPOILS <br /> = o <br /> Contamination Noted: ❑ Yes ❑No — <br /> C <br /> If yes, spoils storage Location: slotted <br /> .on - <br /> Covered: ❑ Yes ❑No <br /> g-­4 Pack <br /> If yes, material: <br /> 1 ,; _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft ft. <br /> Grout Material: <br /> Gallons of Grout Used: s S MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation *ell Destruction Blank Feet Screen Feet <br /> vv Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑ V� <br /> h, ' <br /> Pressure Grout Over Drill l� W Type/Brand of Bentonite:Filter Pack Type/Size: <br /> ❑ Gravity T remie ❑Other: Type of Method: <br /> 10- <br /> Water Cement 471b Water Cement 941b <br /> gall Bags eallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags 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 lb 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 />