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' SAN-J0A0UIN <br /> f-A <br /> Environmental Health Department <br /> " t J —COUNTY— <br /> , •�Oy4 ?`;/ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: inspector: .i _ CONSTRUCTION <br /> Facility Address; <br /> Well Address: LaAANOP Total Depth: <br /> WP#_OO!ASO% Well#: Drilling Rig Type: <br /> Soil Boring#: 01 <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ElYes ON <br /> Driller Onsite; lXvAt&Anr Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: rGN ymmuel Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes,location and distance: height , <br /> SAMPLING �pynOC,no <br /> Holding Temperature: coMait rleiN «,PLETiON <br /> Method: Gmind8nlan <br /> Screening Method: er(a i <br /> Verified Chain of Custody: ❑Yes ❑No s---ft• <br /> SPOILS <br /> a <br /> Contamination Noted: ❑Yes ❑No r <br /> If yes,spoils storage Location: 4to .2 <br /> Covered: ElYes ❑Noon <br /> If yes,material: <br /> GROUTING.or-DESTRUCTION Total Depth:-2°1-�Z�l� Ll (2�•�! ... <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: U01PI, Casing Type: <br /> ❑Well installation KWell DestructlonlK* )\ Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 12113cring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Cover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ;KTremle ❑Other: Type of Method: <br /> Water ment 471 Water Qment9ft <br /> Ions Ba s Rallons BaRs <br /> Thickest Thinnest ags Thlft,t Thinnest NBags leentonitexementMix 3%MIX 5%Mix <br /> 2s 5 1 5 to 1 Bentonite per 47 lb 1.41 2,47 <br /> s 19 2 10 20 a Bentonite per 941b 1 2.82 4.7 <br /> 7,s 15 8 I5 80 <br /> 10 20 4 20 40 4 <br /> 125 25 5 25 50 5 <br /> Is 80 6 80 60 6 <br /> 17.5 85 7 as 70 7 <br /> 20 40 0 40 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-34201 F 209 464-0138.1 www.sjcehd.com <br />