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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness <br /> OUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> �r lV/9 <br /> Date: Ins ector: ��� � � / CONSTRUCTION <br /> Facility Address: 2 �� W� -� /L <br /> Well Address: Total Depth: <br /> WP# 0c) ,39qLIS Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: �- no <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: -T; I,n Screen Length From: To: <br /> Consultant: f'�SK, Af90G`b1 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 ABOVE-GROUND <br /> Holding Temperature: I OWLErION CPOMPt EMON <br /> Method: Ground Suface ' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �n. <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No a <br /> If yes, spoils storage Location: abnod <br /> s.clon 4 — A <br /> Covered: E] Yes El Nozp <br /> 9"101 pack <br /> If yes, material: /I <br /> GROUTING or DESTRUCTION Total Depth: :S T __ <br /> Depth to Water: tL — -IL <br /> GroutMaterial: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation'� Slot Size: <br /> oring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity Wremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izallons Baits <br /> Thickest Thi est #BAR Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />