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C <br /> SAN JOAQUIN Environmental Health Department <br /> —COUNTY' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Z <br /> Date.-4-/a ')70 Inspector: CONSTRUCTION <br /> Facility Address: 3 � <br /> Well Address: Total Depth: 5 <br /> WP# Well#: 3 �Sj Drilling Rig Type: <br /> Soil Boring#: 5' Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: S <br /> Driller Onsite: Green Length From: To: <br /> From: To: <br /> Consultant: - �I• IS Filter Pack <br /> Geologist: _IS Bentonite From: To: <br /> out From: To: <br /> Public Water System Onsite: ElYes El6i C MPLETION ❑ Stove Pipe ❑Christie Box <br /> ns� -i <br /> Domestic Well Onsite: El Yes ❑N !2 casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: coi�t.Frt°N CCoMPPLEMON <br /> Method: Ground Surf"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No =` <br /> If yes, spoils storage Location: slotted = 3 <br /> s�cJon — <br /> Covered: ❑ Yes ❑No <br /> g-vW pack <br /> If yes, material: EE <br /> z = <br /> GROUTING or DESTRUCTION Total Depth: : _= <br /> Depth to Water: n. n' <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Boring Destruction 6� �p���; Bags of Cement: <br /> METHOD USED Per, AXI Bags Sand/Gravel: <br /> ❑Pressure Grout []Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity Cremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest J1 Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5- 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 4.7 <br /> 7.5 15 15 30 3 <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 35 7 35 70 7 <br /> 20 40 6 40 80 8 <br /> 10/16/2017 <br /> c dl C(� �' >< I <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />