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SAN JOAQUIN Environmental Health Department <br /> - COUNTY <br /> Greatness nnis <br /> tt Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 � D Inspector: W CONSTRUCTION <br /> Facility Address: U Vj J1 <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring : fz -!, (� �' 6s, R2�3��b <br /> Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: Ca Y- <br /> 5 Driller Onsite: /}�. r L C�, c1-- <br /> e tUl Screen Length From: To: <br /> Consultant: a0 Filter Pack From: To: <br /> Geologist: �� �l� �� Bentonite From: To: <br /> Z Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No C(Od -COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ElYes El No casing <br /> If yes, location and distance: height <br /> SVj SAMPLING AWIVE-GROUND <br /> Holding Temperature: VC) Cot+FLErI°N COMPt 014 <br /> Method: Gmnd s"rl'c' <br /> Screening Method: olotA <br /> Verified Chain of Custody: ❑ Yes El No —`---n• <br /> SPOILS <br /> a <br /> m <br /> Contamination Noted. ❑ Yes ❑No <br /> If yes,spoils storage Location: cloned <br /> sacdon <br /> Covered: ❑ Yes ❑No = a� <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: : _ <br /> Depth to Water: n• tt <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> oring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> MET D USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 7kravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags eallons Bags <br /> Thickest h nnest 9Bags Thickest Thinnest kBags Bentonite/Cement Mix 3% Mix 55% Mix <br /> z.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 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 I (�' <br /> 15 30 6 30 60 6 N�' l �v� �� JD r <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 NVL 1 S G/VI <br /> -rU 10/16/2017 <br /> CO r ✓K 0� <br /> ;1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 IF 209 464-0138 1 www.secehd.com <br />