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SAN JOAQUIN Environmental Health Department <br /> --COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: .Z !�-� 2� Inspector: Sca ll,ru,, CONSTRUCTION <br /> Facility Address: —52 jVl&ri' ' <br /> Well Address: Total Depth: <br /> WP# 7 L- CSC Well#: Drilling Rig Type: <br /> Soil Boring#: b Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: � QCj1tPf! 6je C, <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ( fie( -tP[� �C 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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: °OWLET ON CCOMPPLEnoN <br /> Method: G=nd S"rl'°' T— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes []No — <br /> If yes, spoils storage Location: <br /> aeon _ <br /> Covered: ❑ Yes ❑No <br /> If yes, material: x <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: / ft Grout Material: <br /> Gallons of Grout Used: ti 12 ti r1 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction` Blank Feet Screen Feet <br /> e: <br /> ❑Boring Installation�Boring Destruction Bags Slot Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity OTremie ❑Other: Type of Method: <br /> Water ement 471b Water Cement 941b <br /> gall Ba Rallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest kBags 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 i 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 L40 <br /> 0 60 6 <br /> 17.5 35 7 5 70 7 <br /> 20 40 B 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />