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oPquiti co <br /> S A N J O A Q U I N Environmental Health Department <br /> COUNTY— <br /> z' <br /> \qP� Greatness grows here. <br /> 1\L/FOP/ <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ZU Inspector: S � t CONSTRUCTION,� <br /> Facility Address: I��Z�V H I D PE 2- <br /> Well Address: Total Depth: <br /> W P#- 4fo):� C' WPII#: Drilling Rig Type: <br /> Soil Boring#: P Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: b <br /> Consultant:—I-,*- <br /> -,F Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: 4�'rIa l 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: height <br /> SAMPLING ABOVE-GROUND cHRI.M-BOX <br /> Holding Temperature: COMPLETION COMPLETION <br /> Ground Suixs <br /> Method: <br /> Screening Method: grout <br /> n <br /> Verified Chain of Custody: ElYes ❑No , <br /> ft. <br /> SPOILS _ <br /> — m <br /> Contamination Noted: ❑ Yes El No <br /> C <br /> If yes,spoils storage Location: stottad W° <br /> a on y' <br /> Covered: El Yes ❑No = va pack <br /> If yes, material: 2 <br /> GROUTING or DESTRUCTION Total Depth: t '` <br /> Depth to Water: 2 <br /> Grout Material UIt �rQr►��✓� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring 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 �Tremie <br /> ❑Other: Type of Method: <br /> Water Cement 471b Water Ce ent 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest gBags Thickest Thinnest ags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 1s 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 /> w IL t2�� • 10/16/2017 <br /> b Pc 2-, ti b(L" & <br /> 1868 E. Hazelton Avenue I Stockto�, Calif6tnia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />