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o> . <br /> SAN JOAQUIN <br /> Environmental Health Department <br /> I`Q t_•'I `/ COUNTY— <br /> `Ssp,�ym� Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7 -23 Inspector: CONSTRUCTION <br /> Facility Address: /4/5-1 /V A4,7 /1 <br /> Well Address: Total Depth: <br /> WP# If qv- Well#: Drilling Rig Type: <br /> Soil Boring#: f,)/' " <br /> Drilling Company: (••tY q Min 2"Annular EHD Seal Verified: El Yes El NO <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 7j:�ICOdS <br /> Filter Pack From: To: <br /> Geologist: �vsw Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: lff height <br /> 10— <br /> SAMPLING ABOVE-GROUND <br /> C0WLETION CF COMPLETION <br /> Holding Temperature: coMn+rlErioN <br /> Method: Ground Surtac� <br /> Screening Method: DR <br /> grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott• <br /> tt. <br /> SPOILS =_ <br /> Contamination Noted: ❑Yes ❑No _ <br /> If yes,spoils storage Location: .gonad <br /> aactlon g'' — B <br /> Covered: ❑Yes El No = <br /> ' parts <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: u�f <br /> Depth to Water: I;p <br /> Grout Material: �-2-1 <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation [Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity A&remie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 4Bags Bentonite/Cement MIX 3%MIX 5%MiX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 is 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 1 7 <br /> 20 40 8 40 80 1 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 />