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SAN;°JOAQUIN Environmental Health Department <br /> - COUNTY— <br /> Greatness grows here. <br /> Q <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: / Inspector: l a-✓fA 4 , CONSTRUCTION <br /> Facility Address: �P�� r9 [i-2 <br /> Well Address: Total Depth: 11� <br /> WP# o -;;7"3 Well#: Drilling Rig Type: `-� A <br /> Soil Boring#: J9 I <br /> Min 2" Annular EHD Seal Verified: ❑ Yes []No <br /> Driller Onsite: SiWtW' <br /> Drilling Company:� �aa'-S � "1Oh Screen Length From: To: <br /> Consultant: CT „ Filter Pack From: To: <br /> Geologist: a e— 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: COMPLETION cOOMP�tfiToN <br /> Method: Ground Surface + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> fi. <br /> h. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No a" <br /> If yes,spoils storage Location: <br /> stoned -_ <br /> &ocdcn <br /> Covered: ❑ Yes ❑No = Vx„W pack <br /> If yes, material: ` <br /> GROUTING or DESTRUCTION Tota Depth: <br /> Depth to Water: - n' <br /> Grout Material: <br /> Gallons of Grout Used: 15 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well 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 /> Gravity ❑Tremie ❑Cit her: Type of Method: <br /> Water Cemen 471b Water T <br /> allons Ba gallons Thickest Thinnest #Bags Thickest Thinnest Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20Bentonite er 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 <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 1 35 7 35 70 7 <br /> 20 1 40 8 40 80 8 <br /> [`b 9 o� ;2,t/JS ioaq10/16/2017 <br /> 1868 E. Hazelton Avenue 11tockton, California 95205 1 T'209 468-3420 1 F 209 464-0138 www.sFcehd.com <br />