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SAN JOAQUIN <br /> Environmental Health Department <br /> —COUNTY- <br /> O94tP'J Greatness grows here. <br /> Q Monitoring Well/Soil Boring Inspection Report <br /> Date: / Inspector: jY-' C�- CONSTRUCTION <br /> Facility Address: \ J �✓ oo S�- <br /> Well Address: Total Depth: <br /> WP# 003 Well#: Drilling Rig Type: <br /> Soil Boring#: "� <br /> l Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: v <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Gtr 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 /> lFa T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION C�oAAFLEnON <br /> Method: G=nd Sul=* <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> SPOILS h. <br /> tt. <br /> SPOILS ; <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: abn.d '' <br /> aKlon _ B <br /> Covered: ❑ Yes ❑No _ t <br /> ack <br /> If yes, material: I r �y� �' <br /> EE <br /> GROUTING or DEST UC p N Total Depth: �� "I tidJp . =_ <br /> Depth to Water: of n' <br /> Grout Material: � <br /> Gallons of Grout Used: Q p MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation oring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> `,� Filter Pack Type/Size: <br /> El Gravity premie ❑Other: Type of Method: <br /> Water ((Cement 471b water Cement 941b <br /> Rall s Bas eallons Baes <br /> Thickest Thinnest #Bags Thickest Thinnest uBags Bentonite/Gement 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 <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 /> X00 (t�� � 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 />