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SAN .J OAQ U I N Environmental Health Department <br /> —COUNTY <br /> c,F +f Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 21 in ector: Q V k , CONSTRUCTION <br /> Facility A dr ss: P°1" <br /> Well Addre5s, f Total Depth: <br /> WP# `' It l Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Lit 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: IT height <br /> T,11 —WW' <br /> SAMPLING ABOVE-GRCUND <br /> Holding Temperature: COWLEMN COMP CCN <br /> Method: Ground Svtacs <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑No 4r —ft. <br /> tt. <br /> ft. <br /> SPOILS <br /> `,1 m <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: <br /> Slotted <br /> Covered: ❑ Yes 11 No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: p � n• tt <br /> Grout Material: oyf , .Y\k- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 25 Q <br /> �— Casing Type: <br /> ❑Well Installation ❑Well Destruction v��lb Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction p� Bags of Cement: <br /> METHOD USED 2�J 1 Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> RGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall Bas allons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest sBags 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 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 ✓ 20' 4 1/ 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 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.s6cehd.com <br />