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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> . , ,• Grenfness grows here. <br /> � �/� �J�� Monitoring Well/Soil Boring Inspection Report <br /> Q <br /> Date: r 1 1012,'7 Inspector: '%Uno, CONSTRUCTION <br /> Facility Address: 30(o W, R(j m Ln <br /> Well Address: Total Depth: <br /> WP# 'J_I4DOD26 Well#: Drilling Rig Type: <br /> Soil Boring#: SIJQ •3 Aryj SVe9 Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: ft r•e <br /> Driller Onsite: Tip r\ Screen Length From: To: <br /> Consultant: PjAbl",L(new 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 ❑No casing <br /> If yes, location and distance: _ height <br /> IEWT <br /> SAMPLING ABOVEGROUND u�Rim-Box <br /> Holding Temperature: °OIP�T1ON COMPLETION <br /> Method: onwnd ssrlaca <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> 9 on yr = B (/ <br /> Covered: ❑ Yes ❑No _ = gravel Pack 1/0 <br /> If yes, material: k <br /> x ^ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: # n' <br /> Grout Material: of covenFMATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ti <br /> Casing Type: <br /> MNell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED 1 Bags Sand/Gravel: <br /> 2,q(IafN1 r .1. Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill �ItQAtr' Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: 1 Type of Method: <br /> Water cement 471b water Cement 941b <br /> allons Bags allons Bags <br /> 7hickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s io 1 10 20 2 Bentonite per 941b 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 11.5 25 5 25 5o 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 00 B <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.sFcehd.com <br />