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Z SAN)JOAHIN <br /> Environmental Health Department <br /> COUNTY— <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Daten 2V,1 Inspector: 00(-r-1 C�, A• CONSTRUCTION <br /> Facility Address: i <br /> Well Addse+s�: L W �` Total Depth: <br /> WP# O Well#: —0q Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: --� Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant:_ C ' Filter Pack From: To: <br /> Geologist: y n Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: OONFLE ON ccoomPLEnoN <br /> Method: G=nd Surf acs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: slotted <br /> sa .on — B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Dept C r = <br /> Depth to Water: �- n• n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation /ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout er Drill Type/Brand of Bentonite: <br /> � �` 1"� Filter Pack Type/Size: <br /> ❑ GravityTremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Bag allons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 10 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 40 80 8 <br /> a�S 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />