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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 26 a Inspector: 1 CONSTRUCTION <br /> Facility Address: ZA oarden &C-16t0c.W. <br /> Well Address: Total Depth: <br /> W P# 0 0 Lk 2 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: III Yes 1:1 No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ` Filter Pack From: To: <br /> Geologist: r `� 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: IF7LT height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COr"F�ION cOMPLE N <br /> Method: Ground Sumacs <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ElYes ❑ n.. <br /> No �tt <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: atoll <br /> s�cdon <br /> Covered: ❑ Yes ❑No _ _ 9-14 Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTIQU Total Depth: 51AA <br /> Depth to Water: n n' <br /> Grout Material: h , <br /> Gallons of Grout Used: — ^ �qj MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction n, t Blank Feet Screen Feet <br /> [� Slot Size: <br /> ❑Baring Installation0oring Destruction Bags of Cement: <br /> METHOD USED Cenfnf T Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill �� ��5 Filter Pack Type/Size: <br /> El Gravity remie ❑Other.' Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest $t Bags Thickest Thinnest MBags 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 to., <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 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.s4cehd.com <br />