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SAN JOAQUIll, Environmental Health Department <br /> COUNTY <br /> Greatness grows hers <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �t ` I ` Inpecto - C� CONSTRUCTION <br /> Facility Address: °� �-- <br /> Well Address: Iti C 0, L10(-I�"K. Total Depth: <br /> WP# �' - Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> � �� Min 2" Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: L <br /> Driller Onsite: -7�C Screen Length From: To: <br /> �+vL Filter Pack From: To: <br /> Consultant: <br /> Geologist: rk 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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION CCOMPLETICN <br /> Method: Ground Six' <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No = r <br /> If yes, spoils storage Location: alone <br /> sacJon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: r� <br /> GROUTING or DESTRUCTION Total Depth: __ <br /> Depth to Water: IF <br /> - ft' <br /> Grout Material: t' <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> Dwell Installation Elwell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring 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 remie ❑Other: Type of Method: <br /> Water Cem t 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnestgs . Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% MIX <br /> z.5 5 1' ; 5 10 1 Bentonite per 47 Ib 1 1.411 2.47 <br /> 5 10 10 20 2 Bentonite per 94 Ib 1 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 /> 15 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.slcehd.com <br />