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SAN„JOAQUIN' <br /> —COUNTY Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �7�ZL inspector: '�`r)r.Slc (�-ar , CONSTRUCTION <br /> Facility Address: <br /> Well Address: ZS/o U Total Depth: <br /> WP# Co Well#: Drilling Rig Type: <br /> Soil Boring#: 1 S 2 I S <br /> Drilling Company: �, c Min 2” Annular EHD Seal Verified: 1:1 Yes 11 No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: <br /> 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 ABOVE-GROUND <br /> Holding Temperature: COt"F�ION comPLEncN <br /> Method: G mnd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: abnod <br /> aeon — B <br /> Covered: ❑ Yes ❑No _ g­+PaCK <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: I X <br /> Depth to Water: n• _ n' <br /> Grout Material: 1 J (� ,� <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 Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> \ Filter Pack Type/Size: <br /> ElGravity ❑Tremie Other: '(i Type of Method: <br /> a r Ceme 1b Water Cement 941b <br /> ons gaill ons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% 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 2.82 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 30 630 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenuel Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s4cehd.com <br />