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SAN JOAQUIN Environmental Health Department <br /> COUNTY" <br /> ...9C,OP�r,•. <br /> Greotnes grows fie, <br /> / Monitoring Well/Soil Boring Inspection Report <br /> Date: Iq Inspector: CONSTRUCTION <br /> Facility A dress: <br /> Well Address: Total Depth: Q if <br /> WP# Q(l an 6 T(� Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: �� Min 2" Annular EHD Seal Verified: El Yes ❑No <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 casing <br /> If yes, location and distance: height <br /> SAMPLING ABC VE-GaovNO <br /> Holding Temperature: COMPLETION c�+�mcN <br /> Method: c3rounds <br /> Screening Method: ori <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abe <br /> arc:cn _ <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt tt. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installationloring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity `�Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas ¢allons Bags <br /> Thickest Thinnest 18ags 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 /> 2U 40 8 40 80 8 <br /> )qac w&tt 2() bq S (U 11b-1) 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s4cehd.com <br />