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SAN JOAQUIN Environmental Health Department <br /> -- COUNTY - <br /> r. <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: A 11 I spector: �T i, E04� CONSTRUCTION <br /> Facility Ad ress: �I .A_ ��Lt V `_CSIcq� <br /> Well Address: T Total Depth: <br /> WP# Well#: IOU LL,. 2A> Drilling Rig Type: <br /> Soil Boring#: — <br /> Min 2"Annular EHD Seal Verified: ElYes El No <br /> Drilling Company: <br /> Driller Onsite: _�►�ct <br /> 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 HNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes =ffNo casing <br /> If yes, location and distance: W- T <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COAFLETION comPL ncN <br /> Method: Ground Svdi4' <br /> Screening Method: orb <br /> M. <br /> Verified Chain of Custody: ElYes ❑No -tt <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: stottad <br /> aacsan <br /> Covered: ❑ Yes ❑No = t <br /> ack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: )r 4. <br /> Depth to Water: tt• ' — tt <br /> Grout Material: (� <br /> Gallons of Grout Used: ,�'� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Nell 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 er Drill Type/Brand of Bentonite: <br /> // __ Filter Pack Type/Size: <br /> ❑ Gravity �(Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags Rallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 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 />