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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY- <br /> 1%51 � Greatness grows here. <br /> �Q Q Monitoring[Well/Soil Boring Inspection Report <br /> Date: �UU Ins ector. w1A A"i 011 �dVO� CONSTRUCTION <br /> Facility Address: '= E- PeOVi h Ka- <br /> Well Address: Total Depth: <br /> WP# © Well#: Drilling Rig Type: <br /> Soil Boring#: - t <br /> Drilling Company: Ge-0 - X Min 2" Annular EHD Seal Verified: [I Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: -C Filter Pack From: To: <br /> Geologist: r_, t d 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 171 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION ccoiviPLEnonxi <br /> Method: Ground Suiacs <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes L1 No .L—tt. <br /> ft. <br /> ft. <br /> SPOILS k <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: slonod <br /> s*cdon _ <br /> Covered: ❑ Yes ❑No = 9­161 v_* <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:`76. 5 Pf <br /> Depth to Water: I , 5 f n- IF <br /> n' <br /> Grout Material: M MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �J O <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation KBoring Destruction Bags iz Cement: <br /> METHOD USED avik _�. 5 % vt Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity YTremie ❑Other: Type of Method: <br /> Water Ceme 47 b Water Cement 94lb <br /> allons Bas 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 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> �1� 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />