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SAK)JOAQUIN <br /> —COUNTY— Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: l 1 Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: p [�a t'I1�_C b�V\, Total Depth: <br /> WP# 7 S Well#: Drilling Rig Type: <br /> Soil Boring#: - <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> �' -�`� � Screen Length From: To: <br /> Driller Onsite: �j>If%, <br /> Consultant: �f�j� 4-C_ Filter Pack From: To: <br /> ,,��\ <br /> Bentonite From: To: <br /> Geologist: <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: T height <br /> —CWT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLEMN COMPLEMN <br /> Method: G=ndSurfacs + <br /> Screening Method: grMn <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: 1 lottod _ B <br /> l[al � on <br /> Covered: ❑ Yes jNo it Q = i,w+�If yes, material: � kEi1A1'GROUTING or DESTRUCTION Total Depth: i O =_ <br /> Depth to Water: L) it - -i-ALICA > —ft. tt' <br /> Grout Material: ot"k (Z- <br /> Gallons of Grout Used: ti (e,✓6")L( L� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation�6oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity mie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> gall s Bas g <br /> allons Bags <br /> Thickest Thinn st 718 Thinnest MBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.s 1 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 30 3 <br /> 10 20 4 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 1 www.secehd.com <br />