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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows Here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ! �/"� Inspector: tL- CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# '� �� �p�j `4 Well#: � Drilling Rig Type: <br /> Soil Boring#: ���` Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 'D®L.t,1019 <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: ooWPLErt°N cawt>nooN <br /> Method: Ground Surface <br /> Screening Method: groat <br /> Verified Chain of Custody: ElYes ❑No ft.ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stood <br /> sac•,ion — <br /> Covered: ❑ Yes ❑No <br /> gmvw Pack <br /> If yes, material: : — <br /> �X <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation [Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ElGravity I Tremie Other: G It/ts Type of Method: <br /> Water ((Cement 471b Water Cement 941b <br /> allons Bags allons Bags <br /> Thickest Thinnest tiBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 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 1 40 8 1 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />