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• (y° SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY- -- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Insppjctor: DW 1Q �� CONSTRUCTION <br /> Facility Address- <br /> Well Address: Total Depth: <br /> WP# O0 3 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: 6 <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: SA j✓ 40-r�L44 Filter Pack From: To: <br /> Geologist: 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 /> tt <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: OONFLETION CaEnO <br /> MPPN <br /> Method: G=nd Strtacs <br /> Screening Method: orart <br /> Verified Chain of Custody: ❑ Yes El No �---n' <br /> it. <br /> it. <br /> SPOILS All <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> s,cdon — 3 <br /> Covered: ❑ Yes ❑No =_ - g-,,wpack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: t4 tL n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation .Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED 3,65 ;j,i Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity �_?ITremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Ba allons Bags <br /> Thickest Thinnest »Bags Thickest Thinnest #Bags Bentonite/Gement 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 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 /> (2 6 1 10/16/2017 <br /> 1868 E. Hazelton Avenue JI Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />