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I <br /> ' '�• "<� SANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> s.i,roa�"• Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: l i1 In{pector: ! V3%' CONSTRUCTION <br /> Facility Address: A X <br /> Well Add re s: Total Depth: <br /> Wp# (,l/ I Well#: Ut=' Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: G Screen Length From: To: <br /> Driller Onsite: = Filter Pack From: To: <br /> Consultant: lr Ut I L Bentonite From: To: <br /> Geologist: � <br /> Y V�' Grout From: To: <br /> Public Water System Onsite: ❑Yes COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes RNO TT height casing <br /> -_ � <br /> If yes,location and distance: <br /> —CWT <br /> SAMPLING A90VE-GROUND CHRMN-Box <br /> COMPLETION COMPLETION <br /> Holding Temperature: GM <br /> Method: grout <br /> Screening Method: <br /> Verified Chain of Custody: ❑Yes ❑No n. <br /> SPOILS = e <br /> Contamination Noted: ❑Yes []No _ <br /> 'f`•� = s <br /> If yes,spoils storage Location: aion°d s' = 8 <br /> aoc.on j <br /> Covered: ❑Yes ❑No gnvolpack <br /> If yes,material: _ <br /> GROUTING or DESTRUCTION Total Depth:__ <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ti If V !�P 4A Casing Type: <br /> ❑Well Installation CPell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ( Over Drill Filter Pack Type/Size: <br /> ❑ Gravity *Tremie ❑Other: <br /> Type of Method: <br /> Water cement 471b Water Cement 94lb <br /> allons Be s aliens Ba s <br /> Thickest Thinnest keags Thickest Thinnest aBags BentonitelCement Mix 3% Mix 5%Mix <br /> 2.s s 1 5 10 1 Bentoniteper 47 lb 1 Al 2.47 <br /> 5 10 2 10 20 2 Bentonite er 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 - 1 35 35 70 7 <br /> 20114 40 1 40 80 0 10/16/2017 <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www s'cehd.corn <br />