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5Mm- (� 25ps ' <br /> SAN JOAQUIN Environmetr11 Health Department <br /> —COUNTY— <br /> weotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date) <br /> o I b 20� Inspector: tM CONSTRUCTION <br /> � <br /> Facility Address: I Total Depth: <br /> Well Address: Drilling Rig Type: <br /> WP#— uV4`��� _Well#: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: nac c - Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To <br /> Consultant: Bentonite From: To: <br /> Geologist:_& N ' Grout From: To: <br /> Public Water System Onsite: ❑Yes %:[ o COMPLETION ❑ Stove Pipe ❑Christie Box <br /> ❑Yes , No casing <br /> Domestic Well Onsite: height <br /> If yes,location and <br /> distance: <br /> ABoY&CiROUND cj8tM430X. <br /> SAMPLING Oo FLFTION COMPLEngN <br /> Holding Temperature: erotiddss+la°.7 "—"—�— <br /> Method: grout <br /> Screening Method: <br /> tt. <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No , = a <br /> ted <br /> If yes,spoils storage Location: `b = $ <br /> ��cticn 4i <br /> ❑Yes ❑No = flti 9l p*C` <br /> Covered: _ <br /> If yes,material: y <br /> GR <br /> OUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: ZQ <br /> Grout Material: ^^^TCQ1 nt c/DEVELOPMENT <br /> Gallons of Grout Used: (OTwA Casing Type: <br /> Blank Feet Screen Feet <br /> ❑Well Installation �WellDestrU ion Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> Bags Sand/Gravel: <br /> METHS Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: <br /> Type of Method: <br /> El Gravity ,,,,,,---���IIi gOTremie ❑Other: <br /> / ,Cement 47lb Water Cement 941b <br /> Water aliens Ba s _ <br /> anon: ea : aaag: mentonlImper941r. <br /> ix 3% Mix 5%Mix <br /> Thickest Tm est psa : Thickest Thinnest _ perlb 1.41 2.47 <br /> s 10 12.82 4.7 <br /> 2.5 5 20 2 53o 2 30 3i <br /> 35 30 <br /> 7.5 15 3 20 40 4 <br /> 2. 20 4 25 50 5 <br /> 1is 25 5 30 6o 6 <br /> 30 6 <br /> 15 7 35 70 7 <br /> 1 35 43 e0 3 10/16/2017 <br /> 20 <br /> 20 40 B <br /> 11868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />