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I <br /> " c\G SAN JOAQUIN <br /> IT C Environmental Health Department <br /> COUNTY - - <br /> �i0po P' Greatness grows here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : J a'L7 Inspector : A* CONSTRUCTION �• � � <br /> Facility Address , /� • .e> �- <br /> Well Address : Total Depth : <br /> WP # oo Z1111 Well # : Drilling Rig Type : <br /> Soil Boring# : Z7e3 N <br /> Min 2 " Annular EHD Seal Verified : ❑ Yes ❑ No <br /> Drilling Company : �'a �'' <br /> Driller Onsite : �� S'� b Screen Length From : To : <br /> Filter Pack From : To : <br /> Consultant : Ag S <br /> Geologist : a ��� <br /> 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 : height <br /> SAMPLING ABOVE-G RCUND <br /> Holding Temperature : COWPLETION COMPti_TON <br /> Method : Ground Surface <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes El No <br /> His <br /> tt . <br /> SPOILS <br /> YA' � <br /> Contamination Noted : El Yes ElNo 4ACD <br /> If yes , spoils storage Location : slog y. <br /> scnI I d — <br /> Covered : ❑ Yes ❑ No v-; <br /> If yes , material : — <br /> ,�. <br /> GROUTING or DESTRUCTION Total Depth : / 0 = <br /> Depth to Water : /0� <br /> Grout Material : /'1s�� c ,� <br /> Gallons of Grout Used : MATERIALS / DEVELOPMENT <br /> Casing Type . <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> ^ I Slot Size : <br /> E] Boring Installation I Boring Destruction Bags of Cement : <br /> METHOD USED Bags Sand / Gravel : <br /> Type/ Brand of Bentonite : <br /> El Pressure Grout ❑ Over Drill <br /> Filter Pack Type/Size : <br /> ElGravity remie ❑ Other : Type of Method : <br /> eic c ent 471b Water Cern ent 941b <br /> gallons aQs crallons Bags <br /> Thir , Thinnest Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3 % MIX % 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 MIIIIIIIIII <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 L L35 7020 40 8 ^00 3 <br /> � ® O 10/ 16 / 2017 <br /> 06 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464 - 0138 www . smcehd . com <br />