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auW �Z� SAN`JOAQUIN <br /> Environmental Health Department <br /> COUNTY— <br /> Greatness <br /> OUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: J�! �! 2 Inspector: ,L� _ CONSTRUCTION <br /> Facility Address: Zi <br /> Well Address: Total Depth: <br /> WP# 00W10-;E Well#: Drilling Rig Type: <br /> Soil Boring#: C <br /> Drilling Company r�� 2 w1 �p�• Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: _i. Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: ��'nGj-ski-c�! �a°u� Bentonite From: To: <br /> Geologist: e�� <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: OOWPIETlON L nON <br /> Method: Ground Surface <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes El No �f. <br /> tt. <br /> SPOILS n. <br /> = e <br /> Contamination Noted: ❑ Yes ❑No =` <br /> If yes,spoils storage Location: afonaa <br /> s�edon "— <br /> Covered: ❑ Yes El No g,,,,wP-* <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: So ?%:�o '• =_ <br /> Depth to Water: 4:�4 fL n' <br /> Grout Material: aw­k !:� <br /> Gallons of Grout Used: �-S Q LLl MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ,,te�ttoring 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 Xremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Ba allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 0Bags 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 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 1 40 80 8 <br /> (� S b 10/16/2017 <br /> 1868 E. Hazelton Avenue �Ockton, California 95205 T 209 468-3420 F 209 464-0138 www.s'cehd.com <br /> II I I 1 <br />