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SASJOAUIN N <br /> c� 0 Environmental Health Department <br /> aL .0 —COUNTY— p <br /> SirP� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �I Ins ctor: CONSTRUCTION 44/-A <br /> Facility Address: i <br /> Well Address; Total Depth:—�✓� <br /> WP# Well#: — ) '2Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: &Ir Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: a Screen Length From: To: <br /> Consultant: nr liter Pack From: To: <br /> Geologist: A(lyrs entonite 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 <br /> SAMPLING ABOVE-GROUND <br /> CONPLEfION COTION <br /> Holding Temperature: car.MPLE�rlFrioN <br /> Method: Ground ssaiacv -- <br /> Screening Method: aroul <br /> Verified Chain of Custody: ❑ Yes ❑No tt <br /> tt <br /> SPOILS <br /> Contamination Noted: El Yes ❑No <br /> If yes, spoils storage Location: <br /> ewnad . _ <br /> _ <br /> Covered: ❑ Yes ONO a4c#on _ a#vol Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:--Zb— <br /> Depth to Water: 1 tt. <br /> Grout Material: 7 <br /> Gallons of Grout Used: �M �, TERIALS DEVELOPMENT <br /> Ca ing Type: <br /> Pkell Installation ❑Well Destruction Slot S at Size: Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons eggs gallons Bags <br /> Thickest Thinnest #eggs Thickest Thinnest #Baas Bentonite/Cement Mix 3%Mix 5% Mix_ <br /> 2.s 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s l0 2 10 20 2 Bentonite per 94 lb 2.82 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 a 40 80 3 <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.s6cehd.com <br />