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P SAN JOAQUIN <br /> Environmental Health Department <br /> aj % — COUNTY— <br /> ``:`rP Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : /�'a ' Zdt� Inspector : / y* 'gt0&"% CONSTRUCTION <br /> Facility Address : 1,90 E • �OjkS, f A*f, <br /> Well Address : Total Depth : <br /> WP# 13CJ L(it 9 9 Well # : Drilling Rig Type : <br /> Soil Boring# : Min 2 " Annular EHD Seal Verified : ❑ Yes El No <br /> Drilling Company : <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : 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 ❑ No casing <br /> If yes, location and distance : height <br /> 7�n <br /> SA r �IWT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature : 00 �' �ION COOiMP�LETION <br /> Method : Ground Surf=* <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes ❑ No <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted : ❑ Yes ❑ No <br /> If yes , spoils storage Location : stonad <br /> wc�on = <br /> Covered : ❑ Yes ❑ No = �, <br /> If yes, material : 40.: <br /> GROUTING or DESTRUCTION Total Depth : / 3 = __ <br /> Depth to Water : 12o ' <br /> Grout Material : /VQgr it 1pf <br /> Gallons of Grout Used : MATERIALS/ DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation Boring Destruction Bags iz Cement : <br /> METHOD USED Bags Sand/Gravel : <br /> ❑ Pressure Grout ❑ Over Drill Type/ Brand of Bentonite : <br /> Filter Pack Type/Size : <br /> ❑ Gravity ❑ Tremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest Bags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> 2. 5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2047 <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 0 30 60 6 <br /> 17. 5 7 35 1 70 7 <br /> 20 0 40 1 80 8 <br /> 10/ 16/ 2017 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. socehd . com <br />