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_ ' z SANS>JOAQUIN Environmental Health Department <br /> -COUNTY <br /> �14 Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: l�l��_ Inspector: J' II IQi f I a�LL CONSTRUCTION <br /> Facility Address: 1 eU 1 <br /> Well Add res VI Total Depth: <br /> WP# Well#: vW� Drilling Rig Type: <br /> Soil Boring#: <br /> DrillingCompany: � �'����. Coo ball Q�JU..Ia� 2 Annular EHD Seal Verified: El Yes ❑No <br /> p y: �� 1 Green Length From: To: <br /> Driller Onsite: <br /> Consultant: ' lC Filter Pack From: To: <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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION COOMPLEnoN <br /> Method: Ground Surface <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes El No -�—n• <br /> ft. <br /> SPOILS = <br /> _ - m <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: .toted <br /> Covered: ❑ Yes El No = � k <br /> If yes, material: <br /> �C <br /> GROUTING or DESTRUCTION Total epth: 13U7 h Z <br /> Depth to Water: N �� tt — ft- <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ti C <br /> YV�1 Casing Type: <br /> ❑Well Installation Well Destruction 1 UVII IIM Blank Feet Screen Feet <br /> �Qk� Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Yp <br /> ver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity AT <br /> remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall Bags gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest ltBags 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 1 www.s*cehd.com <br />