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""c:` SAN lOAQUIN p Environment " Health Department <br /> {M <br /> —COUNTY-Greatness srov;s here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> STRUCTION <br /> Date:\o`, Inspector: <br /> Facility Address: g�a�— Total Depth: <br /> Well Address: ��� v Well#?1-� Drilling Rig Type: <br /> SJ 1 t>r Min 2"Annular EHD Seal Verified: El Yes DNo <br /> soil Boring#: To:. <br /> Drilling company: Screen Length From: To:. <br /> Filter Pack From: <br /> Driller Onsite: � j From: To:. <br /> Consultant: ate` ��- Bentonite To: <br /> Geologist: '- .nJ Grout From: <br /> Public Water System Onsite: <br /> 'Yes ONO COMPS El stove Pipe ❑Christie Box <br /> o casing <br /> Yes <br /> Domestic Well Onsite: __�� heyyht <br /> If yes,location and distance: <br /> AgpvE.&ROUND Cori T"ox <br /> SAMPLING`J'P Cotar>F1wN COMP' <br /> Holding Temperature: ---- <br /> Method: �_n. <br /> screening Method: H, <br /> ❑Yes ❑No ten. <br /> Verified Chain of Custody: <br /> SPOILS o ON = s <br /> ❑Yes <br /> fro - <br /> Contamination Noted.,t.l)�11 �T � A°trail <br /> If yes,spoils storage Location: — sac�j°n <br /> FEE <br /> yr,,al vacx <br /> %Yes ❑No <br /> Covered: <br /> if yes,material: ��, , = tt <br /> GROUTING or DESTRUCTION Total Depth: g, <br /> Depth to Water: ..wrool nl c/DEVELOPMENT <br /> Grout Material: �_ — <br /> °� ^� — Casing Type: Feet <br /> Gallons of Grout Used: Blank Feet screen <br /> pWell Installation <br /> hell Destruction slot Size: <br /> Bags of Cement: <br /> ❑Boring Installation ❑Boring Destruction Bags Sand/Gravel: <br /> METH Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑Pressure Grout [Over Drill Type of Method: <br /> ❑ Gravity kTremie ❑Other: <br /> Water cement 9416 <br /> Water cement 471b Be s 3%Mix 5%MIX <br /> Ba s aliens BentonitelCement Mix <br /> aliens uaggs _ 1.41 2.47 <br /> Thickest Thinnest Bentonite per#P <br /> Thickest Thinnest ueags 5 10 1 _ 2.82 4.7 <br /> 2. 10 1 10 30 a Bentonite per 94 ID <br /> z <br /> 15 <br /> 7.5 15 3 20 40 4 <br /> 10 20 4 25 50 5 <br /> 12.5 25 50 30 60 6 <br /> 1s 30 7 35 70 B 10/16/2017 <br /> 17.5 40 BO <br /> 20 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www si_ceh <br />