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SAN J OAQ U I N Environmental Health Department <br /> COUNTY <br /> Qreotness grcJws here. <br /> �} q�� Monitoring Well/Soil Boring Inspection Report <br /> Date: I / 2 01W Inspe� r: CONSTRUCTION <br /> Facility Address: J 0 <br /> —0t <br /> Well AddrTotal Depth: h p <br /> WP# ll '�'" Well#: Drilling Rig Type: M U Cot", <br /> Soil Boring#: fig. , <br /> Drilling Company: - Pi 1 SaY1 In 2"Annular EHD Seal Verified: El ❑No <br /> Driller Onsite: r Screen Length From: To: <br /> Consultant: Y- Filter Pack From: To: <br /> Geologist: 1 Y' 54 o k, 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: IffT height <br /> SAMPLING AsovE-DRCXJND <br /> Holding Temperature: 00&FLE'r{0N COMPLEMN <br /> Method: G=nd Surto. <br /> Screening Method: act <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> -ft. ft. <br /> ft. <br /> SPOILS — <br /> _ <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: <br /> sac�an '— <br /> Covered: ❑ Yes ❑No = <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: = <br /> Depth to Water: �- <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 11\1'' l' ^ f - J Casing Type: <br /> ❑Well Installation ❑Well Destruction 1S Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation �\Boring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity Aremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest xBags 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 Ib2.82 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 1 / <br /> 130 6 30 0 <br /> 17.5 <br /> 35 35 70 7 <br /> 200 77 <br /> 40 B 40 80 S � <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.s*cehd.com <br />