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SANoJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: In ector: 125 fill <br /> CONSTRUCTION <br /> Facility A dress: <br /> Well Address:r� Total Depth: <br /> WP# X W10 Well#: M vJ $Z Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: (a?a1GPi <br /> Driller Onsite: iApl�� Screen Length From: To: <br /> Consultant: Z Filter Pack From: To: <br /> Geologist: W1 , Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes LINO COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: height: <br /> SAMPLING ABOVE-GROUND <br /> CoNFLE'rlON compLEnoN <br /> Holding Temperature: coMriE]ioN <br /> Method: Ground Suiao <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n <br /> —n. <br /> n. <br /> SPOILS — <br /> T . <br /> Contamination Noted: ❑ Yes ❑No4 = y. <br /> If yes,spoils storage Location: <br /> Covered: ❑ Yes ONO _ gnvolpack <br /> If yes, material: 3s <br /> 1 <br /> GROUTING or DESTRUCTION Total Depth: vzoy = . <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: .V MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation P! Yell Destruction /Ir Blank Feet Screen Feet <br /> []Boring Installation El Boring Destruction / I �9 Slot Size: <br /> 111 Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Ipressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ent 471b Water Cement 94lb <br /> allons B gallons Bags <br /> Thickest Thinnest ags Thickest Thinnest ueags Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47lb 1.41 2.47 <br /> s 30 2 10 20 2 <br /> ZS 15 15 30 3 Bentonite per 94 lb 2 3 � .82 4.7 <br /> , <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 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 />