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° ) SANJOAQUIN Environmental Health Department <br /> —COUNTY— .,.. . <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 b�(f Inspector: �YWwc ' CONSTRUCTION <br /> Facility Address: 1 2 1 <br /> Well Address: otal Depth: <br /> WP# l��l ��. Well#: , je-tilingRigType: <br /> Soil Boring#: Min 2n Annular EHD Seal Verified: ❑Yes []No <br /> Drilling Company: r tl Screen Length From: To: <br /> Driller Onsite: OwLAX <br /> Consultant: Lb 5 L Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: :50H <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes "o COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑A casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GROUND cfwsrreox <br /> Holding Temperature: CowLEr10N ccrnat.Enohi <br /> ,� C4ound Suiac+ <br /> Method: <br /> Screening Method: grout <br /> A-n. <br /> Verified Chain of Custody: ❑Yes ❑No n, <br /> SPOILS <br /> Contamination Noted: ❑Yes g(No <br /> If yes,spoils storage Location: .totted _ $ <br /> action el <br /> Covered: ❑ Yes El No = or, apace <br /> If yes,material: '� <br /> GROUTING or DESTRUCTION Total Depth: t/9 v A0 <br /> Depth to Water: �� <br /> Grout Material: >� ATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 0 1 f 1� Casing Type: <br /> ❑Well Installation FeMell 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 2f remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Ba s allons Ba s <br /> 12.5 <br /> st Thinnest 9 Bags Thickest thinnest a Bags Bentonite/Cement Mix 3%Mix 5%MIX <br /> 5 1 5 10 1 Bentonite er 47 Ib 1.41 2.41 <br /> 10 2 10 20 2 Bentonite er 941b 2.82 4.7 <br /> 15 3 15 30 3 ' <br /> 20 4 20 40 4 25 5 25 50 511 30 6 30 60 6 35 7 35 70 7 <br /> 20 7- 40 40 1 80 1 <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 />