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1 SAN JOAQUIN Environmelr.al Health Department <br /> —COUNTY— <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 141-11 Inspector: AiCAr . CONSTRUCTION <br /> Facility Address: /NS C' 6viP« .rr-E <br /> Well Address: Total Depth: <br /> WP# ev&fV-1 Well#: Drilling Rig Type: <br /> Soil Boring#: B/ l 3k, S: ._ Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes,location and distance: In height <br /> Iffi— <br /> SAMPLING ABOVE-GROUND �j�X <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: G=nasena<s — <br /> Screening Method: of0 t <br /> Verified Chain of Custody: ❑ Yes ❑No tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: B 3' ya S started <br /> socdon <br /> Covered: ❑ Yes ❑No = gravel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: /6'� <br /> Depth to Water: PO rsalJ tt. — tt. <br /> Grout Material: A/4W'/ ea`" MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 71, 7 Z Z S 2v 7, <br /> 9 / Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction 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 Bags 2allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement MIX 3% Mix 5%Mix <br /> 2.5 5 1 s 10 1 1 lBentonite Per47lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 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 40 8 40 80 8 <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.s'cehd.com <br />