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SAN J OAQ U I N Environmental Health Department <br /> COUNTY -- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I(P2,11S(I Inspector: CONSTRUCTION 3 3 ) I � A4 e .b, <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# xp W7.3,3_ Well#: Drilling Rig Type: )5—c4 <br /> Soil Boring#: Arz <br /> Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: �'a,_jeezle <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Ab,,(-) 41,1ek Filter Pack From: To: <br /> Geologist: /efa Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING A80VE-GROUND <br /> Holding Temperature: COMPLETION c1FTC14 <br /> Method: Ground Suf"c' <br /> Screening Method: graA <br /> Verified Chain of Custody: ❑ Yes ❑No -�—h' <br /> h. <br /> n. <br /> SPOILS = <br /> = m <br /> Contamination Noted: ❑ Yes ❑No 37 = <br /> If yes,spoils storage Location: Blo <br /> nad -6 <br /> soon — B <br /> Covered: ❑ Yes El No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 17-i,- <br /> Depth to Water: n n' <br /> Grout Material: A16;,1l?ivV4j <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation El Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ],pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity rXlTremie ❑Other: Type of Method: <br /> Water ment 4'.9b water Cement 941b <br /> gallon gall ons Bags <br /> Thinnest 9Bags Thickest Thinnest .1 Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2Bentonite 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 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> yCd 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />