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A .�Gl!1.4�..� <br /> %' = ' ` SANoJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> " _/ <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 2 Insp CONSTRUCTION <br /> Facility Address: ector: \PIGS <br /> Well Address: Total Depth: <br /> WP# V� Well#: Drilling Rig Type: <br /> Soil Boring#: r i.`� �_\ Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Company: C nnE1VQ�n(,Q. <br /> Driller Onsite: NfrL&(- Screen Length From: To: <br /> Consultant: - Filter Pack From: To: <br /> —X �LZ �V t YonlMQlli- <br /> Geologist: U),\\ Bentonite From: To: <br /> 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: In height <br /> POT <br /> SAMPLING ABOVEEdROUNO CHRIS7143OX <br /> Holding Temperature: COM'I-ET1ON COMPLETION <br /> Method: GrWnd s"t"' <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes ❑Noft• <br /> N. <br /> SPOILS <br /> — e <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: •bn4dIs <br /> s <br /> a4edon ' = S <br /> Covered: ❑ Yes ❑No _ 1W pack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: Qphlo t - MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Or,, q40 . Casing Type: <br /> ❑Well Installation R,Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> KPressure Grout Dover Drill Filter Pack Type/Size: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water ment471b Water Cement 941b <br /> allons Baits allons Ba s <br /> Thickest I Thinnest gs Thickest Thinnest BBags _ Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 1 , lilt 5 to 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 W255 <br /> 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 36 3 <br /> 10 20 40 4 <br /> 12.5 25 s0 5 <br /> 15 30 60 6 <br /> 17.5 20 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 />