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SANJOAQUIN Environmental Health Department <br /> --COUNTY- <br /> Monitoring <br /> C OU N TY- <br /> Mon,�itoring Well/Soil Boring Inspection Report <br /> Date: ? Vj 61k Inspector: CONSTRUCTION <br /> Facility Address: H VJ <br /> Well Address: vey v P uTotal Depth: <br /> WP# 3 Well#: ' rilling Rig Type: r1 c> e4 <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: y Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist:� Gt I A Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETON roN <br /> Method: G=nd Sia" <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> SPOILS = ZI <br /> Contamination Noted: ❑ Yes 11 No <br /> If yes, spoils storage Location: <br /> on = v <br /> Covered: ❑ Yes ❑No <br /> _ — ons+P.-k <br /> If yes, material: <br /> GROUTING or DESTRUCTION tal Dept _ <br /> Depth to Water: �A �+ Ni2� 21 <br /> n <br /> Grout Material: 't <br /> Gallons of Grout Used: ATERIALS DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction b� Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity �KTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest >rBags Benton lte(Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> A,P 0J /16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 �F209 4 4-0138 1 www.secehd.com <br />