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f' " �• SANJOAQUIN <br /> —coulvTv— Environmental Health Department <br /> �•G4 .". Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 'flwfl 3 Inspector: �' CONSTRUCTION <br /> Facility Address: s r DiSti'1v�. <br /> Well Address: Total Depth: <br /> WP#-fi)Q41I C, Well#: 6(1 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: -- Screen Length From: To: <br /> Driller Onsite: � <br /> Consultant: Arr&dt 5 Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: O Yes Ell No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No <br /> oasin5 ' <br /> If yes,location and distance: height <br /> SAMPLING +ti3ov� atw�o <br /> Holding Temperature: cor,Pt> TtortopN <br /> Method: ------C3rotind Surtssca <br /> Screening Method: grout <br /> Verified Chain of custody: ElYes ❑Noa• <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No <br /> if yes,spoils storage Location: 9 <br /> atotwsi <br /> Covered: ❑Yes ❑No ate5on <br /> If yes, material: C <br /> GROUTING.or-DESTRUCTION.Total Depth:-� �•J <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> OWell Installation Well Destruction SDI I Vol�br Blank Feet Screen Feet <br /> �1.0�1 Slot Size: <br /> ❑Boring Installation ❑Boring Destruction gags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> .gGravity OTre ❑Other: Type of Method: <br /> Water meat 471 Water Cement941b <br /> allons gallons 88 <br /> Thickest Thinnest Bags *Thickest Thinnest #Bags SentoniteXament Mix 3%Mix 5%Mix <br /> z.5 s 1 s 10 1 1 Bentonite per 471b 1.41 2A•7 <br /> s w 2 10 1 20 z 113entorille per 941b 2.82 4.7 <br /> 7.5 15 a 15 80 a <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 1s 80 6 30 60 • 6 <br /> 17.5 a5 7 35 70 7 <br /> 20 40 8 40 80 8 ' <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138.1 www.sfcehd.com <br />