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SAN ,J OAQ U I N Environmental Health Department <br /> —COUNTY - <br /> ---. CireOir!r"SS grOv;s <br /> c� <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 8 ( Inspector: d �Yt ONSTRUCTION <br /> Facility Address: H w \1 OUM a -i 1 q <br /> Well Address: otal Depth: <br /> WP# 6 0 7R 77,q Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: q Lt r <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 El No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes []No WT <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND CHR_ <br /> Holding Temperature: COMPLETION COPLEnc <br /> MN <br /> Method: Ground Sudwt '+ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> ft. <br /> tt. <br /> SPOILS <br /> v4 O <br /> Contamination Noted: ❑ Yes ❑No — <br /> C <br /> If yes,spoils storage Location: •bnad = B <br /> nac�on <br /> Covered: ❑ Yes ❑No Pack <br /> If yes, material: x <br /> y� rte. <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n• n' <br /> Grout Material: al <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation jBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 'Premie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons —Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest uBags 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 2.82 4.7 <br /> 7.5 15 3 15 30 3 1 I� <br /> 1s°5 25 s zs 0 s a 1 1 ' <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 ao a ra1d'6)20"1 W+v r <br /> ;J 6 17 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />