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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness graves fieri:. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: L,.,- X Ls�l <br /> CONSTRUCTION <br /> Facility Address:q c/L� !V A3�� <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> �� Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: �ur.►iw-c2r ��ws Screen Length From: To: <br /> Driller Onsite: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COQ�' 1ON coWLETTC�HRtswIoN <br /> Method: (mond Sonate <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No f" <br /> fi. <br /> fi. <br /> SPOILS ' <br /> Contamination Noted: ❑ Yes ❑No = o <br /> If yes, spoils storage Location: sioir" <br /> ss on '— <br /> Covered: ❑ Yes ❑No = ,iw ; <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 3 <br /> Depth to Water: " <br /> Grout Material: b • 7 S <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> ,���� Casing Type: <br /> [7Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> El Gravity L�'fremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 94Ib <br /> gallons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41F <br /> .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 /> 1 20 4 20 40 4 <br /> 12.. �15 25 5 25 50 5 _ �f 9 <br /> 15 30 6 30 60 6 <br /> 17.5 35 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 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />