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SAN JOAQUIN Environmental Health Department <br /> COUNTY - <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z3 Ins ectorr* fir" CONSTRUCTION <br /> Facility Address: ict�G fy <br /> Well Address: Total Depth: <br /> WP# 00 ��', Well#: -Q� Drilling Rig Type: <br /> Soil Boring#: / Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ' 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 ONO casing <br /> If yes, location and distance: I height <br /> SAMPLING A80VEAgWND <br /> CONPGROUN CHPoSfY43OX <br /> Holding Temperature: COMPLE ON <br /> Method: Ground Sulacv — — <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes []Non• <br /> n. <br /> SPOILS <br /> e <br /> Contamination Noted: ❑ Yes ❑No " _= " <br /> If yes,spoils storage Location: sbnod <br /> suction <br /> Covered: ❑ Yes ❑No = �� <br /> If yes, material: <br /> GROUTING or DESTRUCTION To al Depth:_ <br /> Depth to Water: <br /> Grout Material:Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> �Z.�,U�'i(� Casing Type: <br /> ❑Well Installation /{Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation`❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest "Bags Bentonite/Cement MIX 3% MIX 5% MIX <br /> 2.5 5 1 5 10 1 1 Bentonite per 47lb 1 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 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 BO 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sacehd.com <br />