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SAN.JOAQUIN <br /> Environmental Health Department <br /> • <br /> COUNTY— <br /> Greatness <br /> OUNTY— <br /> Greatness grows here. <br /> 2 Monitoring Well/Soil Boring Inspection Report <br /> Date �> Inspector: /�'✓�^ 1 CONSTRUCTION <br /> Facility Address: T'w-Q 2,re C2 11�, ", <br /> Well Address- Total Depth: <br /> WP# 0 0qWell#: Drilling Rig Type: <br /> Soil Boring#: C 20--0 D —QS <br /> Drilling Company: e�— Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: _` Screen Length From: To: <br /> Consultant: S_ 0-0 Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> ��^�1 - <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 ABOVE-GROUND <br /> Holding Temperature: GOI�LETION COMPLEnoN <br /> Method: Ground Surface <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes []No �ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No r° _ <br /> If yes, spoils storage Location: slotted _ B <br /> wclon _ <br /> Covered: 11 Yes ❑No C{�Z�_0 10 <br /> gnwt pack <br /> If yes, material: u-_'70-0 S, 10 l <br /> GROUTING or DESTRUCTION Tot I �epth: _'F d T '1 �- <br /> Depth to Water: �` l 19 tL n' <br /> Grout Material: VA MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: a0LI)OnS 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 /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity gTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cem t941 <br /> allons Bas izallons B <br /> Thickest Thinnest sBags Thickest Thinnest ft Bags 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 2.821 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 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 80 8 <br /> �Q , 0 'q 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, C <br /> alifornia 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />