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SAN JOAQUIN Environmental Health Department <br /> COUNTY--- <br /> , Greatness grows here. <br /> '] �/'' Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: , CONSTRUCTION <br /> FacilityA dress: tYA W. U- W i �, <br /> Well Address: Total Depth: <br /> WP# 2it�(�QI'LC) Well#: �N � Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: (�Q <br /> Screen Length From: To: <br /> Consultant:Driller Onsite: Iy1df.,�M Filter Pack From: To: <br /> Geologist: � Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Co1.�LETION crwlm-sox <br /> Holding Temperature: COMPLETION <br /> Method: Ground S rlacc <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ONO ft. <br /> fl. <br /> SPOILS _ e n — - <br /> Contamination Noted: ❑Yes ❑No 7c <br /> If yes,spoils storage Location: cloned ' = s <br /> cloned <br /> Covered: ❑Yes ONO l = <br /> grew)Pack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt. = ft.Grout Material: nfi MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <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 Dover Drill Type/Brand of Bentonite: <br /> A Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ment 471b Water Cement 941b , <br /> allons Baas eallans Bags <br /> Thickest Thinnest ags . Thickest Thinnest 4aa91 Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 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 0 40 80 3 <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 />