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SAN JOAQUIN---COUNTY Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: (I'LA_ Inspector: .V,4-ft6M CONSTRUCTION <br /> °Facility Address: dU iv, " . r <br /> Well Address: Total Depth: <br /> WPN 9� Well#: BMW `I �fiq Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Com an Y1 <br /> Dyiller Onsite: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> p y Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist:_ AlZerxA nl' tv2 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: 0 ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: � height T. <br /> SAMPLING ABOVEEGROUNO T <br /> COWLS ION COMPLEMOX <br /> con+riEri Holding Temperature: oN <br /> Method: Ground surlaea <br /> Screening Method: grog <br /> r <br /> Verified Chain of Custody: e ❑ Yes ❑No n' <br /> —n. <br /> n. <br /> SPOILS <br /> e . <br /> Contamination Noted: ❑ Yes ❑No T"= J_ <br /> If yes,spoils storage Location: , abttaa <br /> 4�eion <br /> Covered: ❑Yes []No — gravol <br /> Pack <br /> If yes, material: / <br /> J <br /> GROUTING or DESTRUCTION Total Depth: 3•J <br /> Depth to Water: tt. <br /> Grout Material: /t'/ C MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation %Well Destruction Blank Feet Screen Feet <br /> Ell Boring Installation El Boring Destruction Slot Size: <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 $0-remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest XBags Thickest Thinnest 9Bags _ BentonitelCement Mix 3% MIX 5'MIX <br /> 2.5 5 1 5 10 lBentonite per 47 lb I IlAll A <br /> 5 10 2 10 20 2 Benlonile per 941b 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 1 <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.s'cehd.com <br />