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SAN -JOAQUIN Environmental Health Department <br /> - COUNTY----- <br /> s Greatness grows here. <br /> 1 <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:l��l Inspector:l l6,r ;A AfcYt O_ CONSTRUCTION <br /> Facility Address: - I t h 5`r <br /> Well Address: Total Depth: <br /> WP# 0 0 3 33 Well#: ' Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company:. <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> � 2r � � �h <br /> Driller Onsite: C A Screen Length From: To: <br /> Consultant: (35K Associ&l�_�_ <br /> Filter Pack From: To: <br /> Geologist: 0 Vv►a'y— 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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLEMN <br /> Method: Ground Surface <br /> Screening Method: V1111 groca <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> tt. <br /> SPOILS 4 <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> aKlon <br /> Covered: ❑ Yes ❑No = Irnw+pack <br /> If yes, material: <br /> I � I � <br /> GROUTING or DESTRUCTION Total Depth:t5 -h I O 4 5 :: 3 O <br /> Depth to Water: �+ n- .� n' <br /> Grout Material: e.0 <br /> Gallons of Grout Used: 0 '3 <br /> .l( nS MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation" oring Destruction n Ii Bags of Cement: <br /> METHOD USED kola G O✓1r Q Lf Iii `� e Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> "Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest sBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 15 kr)(aVI� 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />