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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> �i,,ov,p`-'� Greatness grows h=_re. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: C�Mird4,pn - <br /> Well Address: Total Depth: <br /> WP# W (��'} Well#: Drilling Rig Type: <br /> Soil Boring#: C.lIr4. Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: C6 A\ l)CY1.t.Q TP kll . <br /> Driller Onsite: q Screen Length From: To: <br /> Consultant: tv& Filter Pack From: To: <br /> Geologist:� Vrl Bentonite From: To: <br /> `J�" Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> COI.FLETION C -BO <br /> Holding Temperature: cOMPLEon4rtETioN <br /> Method: cva,ndS <br /> Screening Method: arari <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> _R. <br /> SPOILS <br /> _ a <br /> Contamination Noted: ❑ Yes ❑No ° =_ <br /> If yes,spoils storage Location: <br /> ?1 = 8 <br /> Covered: ❑ Yes ❑No aecdon 1 — wavelpack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth:�•S' <br /> Depth to Water: <br /> Grout Material: mif OMAI& MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: '- 100 Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity 5ZTremie ❑Other: Type of Method: <br /> Water cyfenl 47I Water Cement 941b <br /> allons f Baas allons Ba s <br /> Thickest thinnest ags Thickest thinnest pBags Bentonite/Cement MIX 8% MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 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 30 60 6 <br /> 115 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 />