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SAN JOAQUIN Environmental Health Department <br /> ---COUNTY <br /> Greatness grows here. <br /> Monii�tori""n''g""""Well/Soil Boring Inspection Report <br /> Date: �T?- Inspector: /V °d,� CONSTRUCTION <br /> Facility Address: 200 b2/tcto/0 �uC <br /> Well Address: Total Depth: <br /> WP# ZI 00// Well#: 6lt7 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: wFlw c G Min 2"Annular EHD Seal Verified: El Yes ❑No <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 El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No —r casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> COWLETION CHPoSTY-BOX <br /> Holding Temperature: coMPlETioN <br /> Method: Ground °na . .:F-- <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott• <br /> tt. <br /> SPOILS <br /> 5<� O IContamination Noted: El Yes ❑ .,No ��� _ <br /> If yes,spoils storage Location: slonad <br /> section <br /> Covered: ❑ Yes ❑No — Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: '-Zo <br /> Depth to Water: )7 r <br /> Grout Material: W CO <br /> Gallons of Grout Used: /.3 o? Dy`t MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation WWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> *ressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5%MIX <br /> 2.5 s 1 s l0 1 Bentonite per 47lb 1.41 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 /> is 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 />