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SAN JOAQUIN <br /> Environmental Health Department <br /> L.s.I'' —COUNTY— <br /> � Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �2 C� �b Inspector: p ✓� A�bY416-� CONSTRUCTION <br /> Facility Address: [3if L- vQ- <br /> Well Address: Total Depth: <br /> WP# DO 39 l0 Well#: Drilling Rig Type: <br /> Soil Boring#: R I Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite:-- 6 ; (, Screen Length From: To: <br /> Consultant: '�Zrrn-C 0vt Filter Pack From: To: <br /> Geologist: lo' 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION CoomPLEnoN <br /> Method: Ground Suiacs <br /> Screening Method: araA <br /> Verified Chain of Custody: ❑ Yes ❑No �---n' <br /> tt. <br /> tt. <br /> SPOILS - <br /> Contamination Noted: ❑ Yes El No r` <br /> If yes, spoils storage Location: slonad <br /> n rp = 3 <br /> Covered: ❑ Yes El No <br /> pravol p-:k <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: __ <br /> Depth to Water: j -I n- n' <br /> Grout Material: Q/ Uiil MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: LA 5 o,l( -� <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet ` -r Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation E�Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity STremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest XBags Thickest Thinnest ttBags 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 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 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 80 8 <br /> 5 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />