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�u'" ? <br /> ° <br /> SAN. JOAQUIN <br /> s �o <br /> Environmental Health Department <br /> ---COU NTY <br /> �qr Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:�� Inspector: �KSk*oNSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: NSA WP# Q0q0 ?30 Well#: Drilling Rig Type: <br /> Soil Boring#: — <br /> Drilling Company: T�-�/�Cv h Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: k-q- o 7 Filter Pack From: To: <br /> Geologist: y, 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: COhFLETION COMP�LEnoN <br /> Method: Ground Sulw* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes []No —`---n' <br /> n. n. <br /> SPOILS <br /> 4s o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: stottod <br /> ascdon = B <br /> Covered: El Yes ElNo y 5 .F"I1 — grz1 t p..k <br /> If yes, material: fO�� <br /> GROUTING or DESTRUCTION Total Depth: 1 5 ,Q5 v ` _ <br /> Depth to Water: n- n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ZZ d taton%t <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 ❑Tremie ❑Other: Type of Method: <br /> Water Ceme 471b Water Cement 941b <br /> allons 8 sRtall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest zBags 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 Ib 2.82 4.7 <br /> 7.5 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 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 209 464-0138 1 www.slcehd.com <br />