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1 <br /> ° \ $ANaJOAQUIN Environmental Health Department <br /> -COUNTY— <br /> i�, ;,,«,,,.•" Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ij 13 Inspector: O I! CONSTRUCTION <br /> Facility A dress: q Ar 4,Go <br /> Well Address: A- 6 Total Depth: <br /> WP# t�/ Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: u rr �t Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist: Grout From: To: <br /> Public Water System Onsite: ❑ Yes Oflo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ENO casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND crRSN-BOX <br /> CO&FL.E ION COMPLETION <br /> Holding Temperature: Ground Sul,a, <br /> Method: <br /> Screening Method: grout <br /> -ft. <br /> Verified Chain of Custody: ❑ Yes ONO <br /> — <br /> SPOILS = e <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: <br /> an '{ <br /> Covered: ❑Yes ONO _ g-vn+pxk <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: l7 <br /> tt. tt. <br /> Depth to Water: <br /> Grout Material: u MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: -1;0p e7 Casing Type: <br /> ❑Well Installation ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑_ oring Installation El 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 PTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Ba s allons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%MIX 5%Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 lb I IAIJ 2.47 <br /> 5 to 2 10 20 2 Bentonite per 94 lb 1 2.821 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 7 35 70 7 <br /> 20 40 40 00 B <br /> 10/16/2017 <br /> '8 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />