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SAN JOAQUIN Environmental Health Department <br /> t, l COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: (U Z Inspector: kV CONSTRUCTION <br /> Facility Address: k�2A Alt, ! lE� lorf\ <br /> Well Address: V 9 Total Depth: <br /> WP# %PO (41SB o Well#: ?Aw i � Drilling Rig Type: <br /> Soil Boring#: PVA <br /> S � Min 2"Annular EHD Seal Verified: ❑ Yes []NoDrilling Company: � Qp"((�4 <br /> Driller Onsite: / Screen Length From: To: <br /> Consultant: AP11A c Filter Pack From: To: <br /> —�Geologist: Bentonite From: To: <br /> n���� <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 ABOVE-GROUND T <br /> C016FLETION COMPLETION <br /> Holding Temperature: cornPiErioN <br /> Method: Ground Sulxv <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ONO ft. <br /> tt. <br /> —n. <br /> SPOILS y <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: <br /> sacion = 8 <br /> Covered: El Yes ONO = gravvi Pack <br /> If yes, material: �� <br /> GROUTING or DESTRUCTION Total Depth: �� 1*0, <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation IFW <br /> ell 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 <br /> Filter Pack Type/Size: <br /> ❑ Gravity (�Tremie ter: ��S� Type of Method: <br /> Water NCement 471b Water Cement 41 <br /> allons Bags Italians Bags <br /> Thickest Thinnest pBags Thickest Thinnest #Bags Bentonite/Cement MIX °o MIX 5°/a MIX <br /> 2.s 5 1 s 10 1 Bentonite er 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94lb 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 6 6 <br /> 17.5 35 7 35 <br /> 20 40 8 40 <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 />