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SAN JOAQUIN Environmental Health Department <br /> !v COU NTY <br /> `�,<«,aN Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1101 Inspect CONSTRUCTION <br /> Facility Address: 21120. ,L (�lCx <br /> Well Address: Total Depth: <br /> WP# C Well#: Drilling Rig Type: <br /> Soil Boring#: I Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: jFVj <br /> Driller Onsite: F{!/Vh. <br /> k Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: �� f Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: COWP�nON cocw�loN <br /> Method: Ground Sufaos <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes []No —`----n <br /> n. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: stotmd <br /> .on <br /> Covered: ❑ Yes ❑No = ate* <br /> If yes, material: , <br /> GROUTING or DESTRUCTION Total Depth: __ <br /> Depth to Water: n — IF n• <br /> Grout Material: CLAIYURyr MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation goring Destruction Bags of Cement: <br /> METHOD USED 1 Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity �Zremie ❑Other: Type of Method: <br /> Water (Cement 471b Water Cement 941b <br /> allons Bas I gall!ons Bags <br /> Thickest Thinnest bBags Thickest Thinnest tlBags 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 lb 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 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 /> 5D)k 1 6"s S 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.slcehd.com <br />