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. SAN JOAQUIN Environmental Health Department <br /> i —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: '� ('/l zo Inspector: Uj CONSTRUCTION <br /> Facility Address: z 3 S 6 a 2 <br /> Well Address: Total Depth: 3�� 3(J <br /> WP# 0, r) +2 0�43 Well#: �jj 2 V 4 Drilling Rig Type: <br /> Soil Boring#: 30 ►� 3d <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: COY ,r Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLS ION COtdP�_LEnON <br /> Method: GroundSurtaes + <br /> Screening Method: orb <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> tt. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No a <br /> If yes,spoils storage Location: slotted <br /> sac Jon r = B <br /> Covered: ❑ Yes ❑No <br /> gravel pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: " =_ <br /> Depth to Water: "ar l'�[e cr t<. — n' <br /> Grout Material: C4;Ek"_'Cj MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation 5dWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Owl Drill Type/Brand of Bentonite: - <br /> Filter Pack Type/Size: <br /> ❑ Gravity Xremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags itallons Bags <br /> Thidrest Thinnest RBags Thickest Thinnest tlBags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 /> 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. Haz on Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sFcehd.com <br />