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SAN JOAQUIN <br /> Environmental Health Department <br /> ---COUNTY--- <br /> �K�gPi Greatness grows here- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:�� Inspector: D(, A - CONSTRUCTION <br /> Facility Address: W oAve, <br /> Well Address: Total Depth: (/ �� I/ <br /> W P# C) Well#: Drilling Rig Type. -I P7 L,� <br /> Soil Boring#: <br /> Drilling Company: ; Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: <br /> Screen Length From: To: <br /> Consultant: oc 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 El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING A OVE-GROUND <br /> Holding Temperature: COtvF ETION comptEncN <br /> Method: Grand Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> tt. <br /> ft. <br /> SPOILS <br /> 4i = a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slatted K <br /> s�csan 4 — B <br /> Covered: ❑ Yes ❑No g-V1W <br /> Pack <br /> If yes, material: <br /> PGROUTING or DESTRUCTION Total Depth: ;: =_ <br /> Depth to Water: Kn• — n' <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 Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity Vremie ❑Other: Type of Method: <br /> Water Cement 471 Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest Ai Bags Thickest Thinnest #Bags 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 10 4 20 40 4 <br /> 11.5 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 /> 11 � / �� 10/16/2017 <br /> 1868 E.`Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br />