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SANsJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1'L 26 Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# MAS b Well#: Drilling Rig Type: <br /> Soil Boring#: w W 2 Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: CII&IaIt f1L� <br /> Driller Onsite: r Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: t�Ptl4an Bentonite From: To: <br /> " Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: IffT hasght <br /> I <br /> SAMPLING ABOVE-GROUND <br /> COWLETION COMPLE-BOX <br /> Holding Temperature: coMPLEr1oN <br /> Method: Oratind SuAacv 7 <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ONO tt• <br /> tt. <br /> SPOILS - <br /> - <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: ' _ <br /> s°c3on �I <br /> Covered: ❑ Yes ❑No — � <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 25 t = 1 <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^AtU rl 27I17i Casing Type: <br /> ❑Well Installation MWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> 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 Wremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement 941b <br /> allons Bags eallons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement MIX 3% MIX 5°/a MIX <br /> 2 5 1 s 10 1 Bentonite er471b 1.41 2.47 <br /> 5 20 2 10 20 2 Sentonite per 94lb 2.821 4.7 <br /> 7.5 15 3 1 is 30 3 <br /> 30 20 4 11 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 3s 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.smcehd.com <br />