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SAN : JOAQUIN <br /> Environmental Health Department <br /> ? COUNTY <br /> L / <br /> Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : /�y Inspector : CONSTRUCTION <br /> Facility Address . �' ( � J, mdef <br /> Well Address : Total Depth : <br /> WP # , N Well # * � 1. Drilling Rig Type : <br /> Soil Boring# : Min 2 " Annular EHD Seal Verified : 11Yes ❑ No <br /> Drilling Company : �� � �i%� ,fir►,` //,�,, ,� <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : ky.utr t,, ' &t'v ,�t _ <br /> Filter Pack From : To : <br /> Geologist : J� ' 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 : height <br /> SAMPLING ASCYVE-GROUND <br /> c*iRISTv-sox <br /> coi� r�ot� <br /> Holding Temperature : COMPLETION <br /> Method : around Stxtxs <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes ❑ No n• <br /> ft. <br /> SPOILS tt• - = <br /> Contamination Noted : ❑ Yes <br /> El No <br /> K C <br /> If yes , spoils storage Location : _� Y <br /> Covered : ElYes ❑ Nom <br /> ,— gravvi pacts <br /> If yes , material : � ` <br /> GROUTING or DESTRUCTION Total Depth : �Depth to W ate r : n- <br /> Grout Material : MATERIALS / DEVELOPMENT <br /> Gallons of Grout Used : <br /> Casing Type : <br /> ❑ Well Installation CWell Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation ❑ Slot Size : <br /> Boring Destruction Bags Sizes <br /> Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> ❑ Pressure Grout ❑ Over Drill Type/ Brand of Bentonite : <br /> Filter Pack Type/Size : <br /> ❑ Gravity )VTremie El Others Type of Method . <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gall ons Bags <br /> Thickest Thinnest ttBags 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 <br /> 17. 5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/ 16/ 2017 <br /> kj <br /> 1868 E . Hazelton Avenue Stockton , California 952051 T 209 468- 3420 1 F 209 464- 0138 www . smcehd . com <br />