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SAN�JOAQUIN <br /> Environmental Health Department <br /> !; ` —COU NTY— <br /> +\cqC' P,� Greatness grows herr._. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �7 27 ins pector: lt CONSTRUCTION I/ <br /> Facility Address: 1. e ala 6 HS Pr <br /> Well Address: Total Depth: <br /> WP# CoAq(1 D Well#: Drilling Rig Type: <br /> Soil Boring#: 131 -2 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: GQQQ <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 /> SAMPLING ABOVE-GROUND _ <br /> Holding Temperature: CONFLETION COMPLEnON <br /> Method: G=nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes []No — <br /> If yes, spoils storage Location: = a <br /> cloned _ 6 <br /> ,►�c.on — 3 <br /> Covered: ❑ Yes ONO <br /> g-vlw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: Soft -_ <br /> Depth to Water: ",' 27 Tt n• n' <br /> Grout Material: N cat C21Mt yt! 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 Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity �gTremie ❑Other: Type of Method: <br /> Water ement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest Jt 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 /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 10 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 /> rj 30UUc'A+ 1 low 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 />