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SAN JOAQUIN Environmental Health Department <br /> COUNTY - <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility A dress: �. <br /> Well Address: Total Depth: <br /> WP# 2vl Ob u N Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: ( Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Driller O �^ Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: w`r1 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO r casing <br /> If yes,location and distance: height <br /> nei9h <br /> E T. <br /> SAMPLING ABOVE-GROUND T <br /> COWLETION COMPLEnoN <br /> Holding Temperature: cottalFrioN <br /> Method: oraandsuiac9' s <br /> Screening Method: Drool <br /> Verified Chain of Custody: ❑Yes ❑No -�—h <br /> n. <br /> SPOILS — <br /> k� <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> Slatted <br /> section '% — <br /> Covered: ❑ Yes ❑No _ aawvack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: Wt 611 LIE <br /> Depth to Water: n• TM• <br /> Grout Material: tjpior C 6tQ,f/1 <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation 71Nell Destruc ion Blank Feet Screen Feet <br /> ❑Boring Installation El Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Ojessure Grout Dover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑T ❑Other: Type of Method: <br /> Water ment 471b Water Cement 941b <br /> allons Ba s aallons Ba s <br /> Thickest Thinnest gs Thickest Thinnest #Bags BentOnite/Cement Mix 3% Mix 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 Z. <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 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 1 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 />