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PQUey <br /> A. <br /> ° ;i SAN JOAQUIN <br /> Environmental Health Department <br /> ... —COUNTY-- <br /> °q �'' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Ca Inspector: 0 CONSTRUCTION <br /> Facility Address: 0 0 SQ CAAA il.',x <br /> Well Address: -� J pa IrCle Total Depth: <br /> WP# Well#: 1 A i• Z Drilling Rig Type: <br /> Soil Boring#: " <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: 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 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: COWLETiON =MPtEnoN <br /> Method: Ground Surface <br /> Screening Method: 51>1grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> fl. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No ` <br /> — c <br /> If yes,spoils storage Location: abtwd _ B <br /> ,iNcJon <br /> Covered: ❑ Yes ❑No _ gr,,,ell pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: -_ <br /> Depth to Water: ft. <br /> Grout Material: <br /> Gallons of Grout Used: 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 ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> gall Bags gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest bBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 2.821 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 <br /> is 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.s4cehd.com <br />