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z <br />y SAN JOAQUIN <br />—COUNTY— <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �II I Inspector: CI�1 GYI CONSTRUCTION <br />Facility Address: 2 W 1(t'I-�i�_11/lU _� bayWo - <br />Well Address: otal Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: \7 — -D\\ <br />Drilling Company: -* W Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Driller Onsite: Screen Length From: To: <br />Consultant: 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 1:1 No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes material: <br />otal Depth: k1/V-2-11 'IZ <br />Depth to Water: o(rL� n• <br />l� Grout Material•��-&C GC, <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br />`�➢ Slot Size: <br />El Boring Installation tKBoring Destruction Bags of Cement: <br />METHOD USED 13( �ot'fd�ys v✓ SIS/ Bags Sand/Gravel: <br />❑Pressure Grout ❑Over Drill q1 0 61S Type/Brand of Bentonite: <br />J Filter Pack Type/Size: <br />❑ Gravity ❑Tremie 00ther:2Type of Method: <br />Water <br />gall s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Bags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />a <br />ao Ba <br />e <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <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.smcehd.com <br />