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SANJOAQUIN Environmental Health Department <br /> - -COUNTY <br /> - Gi�utnG:>S grov,s , <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:: 2` Inspector: i(YLJ CONSTRUCTION <br /> Facility A ress: <br /> Well Address: Total Depth: <br /> WP# CQALWell#: Drilling Rig Type: <br /> Soil Boring#: MW _ Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: rk F"l <br /> Driller Onsite: �Q,{rVIP�, Screen Length From: To: <br /> / Filter Pack From: To: <br /> Consultant: <br /> Geologist: / 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 ❑No casing <br /> If yes, location and distance: wl <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION COMPLETION <br /> Method: Ground Su face <br /> Screening Method: arrow <br /> Verified Chain of Custody: ❑ Yes El No —` n• <br /> n. n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes 11 No <br /> If yes, spoils storage Location: aloud �� <br /> aacdon "— B �� oAk <br /> Covered: ❑ Yes ❑No g, w Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION,Total Depth: 54-. <br /> Depth to Water: —ft. ft. <br /> Grout Material: ALL} Nj�rx . <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ti VO <br /> Casing Type: <br /> VANell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El Boring Destruction <br /> 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 "SI.Tremie ❑Other: Type ofLMethod: <br /> ` + DyW� <br /> Water Cement 471b Water CeTint 94 b ' W' "4 MIS <br /> allows Bas gallows <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 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 I www.s*cehd.com <br />