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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: i a0 r: CONSTRUCTION <br /> Facility Address: k , !.4 <br /> Well Address: i pW Total Depth: <br /> WP# 4Ato� Well#: Mw"�3 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: (_a iLy <br /> Driller Onsite: 'r"AI)X Screen Length From: To: <br /> Consultant: LOA S Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes QNo casing <br /> If yes, location and distance: f height: <br /> SAMPLING ABOVE-GROUND cHRMW-Box � <br /> Holding Temperature: Co&FLETioN COMPLErioN <br /> Method: Ground 8u1ac+ <br /> Screening Method: groin <br /> Verified Chain of Custody: ElYes ❑No —n' <br /> �n. <br /> n. <br /> SPOILS — <br /> Contamination Noted: ❑ Yeslo <br /> If yes,spoils storage Location: awrwa = s <br /> s�cdon = 8 <br /> Covered: ❑ Yes ONO 9mvel Pack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: Go <br /> Depth to Water: aW <br /> Grout Material: 0p. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 2 I No ga&k* <br /> Casing Type: <br /> ❑Well Installation OWell 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 RJTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 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 35 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.secehd.com <br />