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SAN JOAQUIN Environmental Health Department <br /> -COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Z6 <br /> Date: Inspector: of CONSTRUCTION <br /> Facility Address: zd/ i` 5 <br /> Well Address: Total Depth: <br /> WP# OO1/��3� Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Mr;�l 6 t°w o i Min 2"Annular EHD Seal Verified: ElYes ❑No <br /> Driller Onsite: Usvr ' Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: height • <br /> SAMPLING ABOVEGROUND T <br /> COMPLETION COMPLE-BOX <br /> Holding Temperature: COMPLETION <br /> Method: Ground Suix. <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑No n. <br /> —n. <br /> n. <br /> SPOILS — <br /> Contamination Noted: ❑Yes ONO z" <br /> If yes,spoils storage Location: .tanoa .j <br /> wo5on _ B <br /> Covered: ❑Yes LINO gmv%4 Pack <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: Z& tt• — n• <br /> Grout Material: n/cec Cezity <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: /SfG9`<l/oa•d Casing Type: <br /> ❑WeII Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation oring Destruction Slot Size: <br /> 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 XTremie ❑Other: Type of Metliod: <br /> Water Cement47lb Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest It Bags Thickest Thinnest #Bags Bentonite/Cement MIX 3% MIX 5%M1X <br /> 2.5 5 1 5 10 1 Bentonite per 47lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 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 1 40 i30 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.s'cehd.com <br />