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SAN. JOAQUIN Environmental Health Department <br /> —COUNTY---- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 23 Inspector: tj�jA CONSTRUCTION <br /> 4_ <br /> Facility Address: Ir <br /> Well Add re vewA oy�y �u hL"� Total Depth: <br /> WP#oo S jq 9 —b0 — 2 Wel#: I S�°v'r Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: v�P�tly. 'KY <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: P� �� �S ;� �'I Filter Pack From: To: <br /> �LYi.PR <br /> Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 1:1 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLET10N C*MP�LEnoN <br /> Method: G=nd Surf=* <br /> Screening Method: orae <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No r" _ <br /> If yes,spoils storage Location: stottad _ 3 <br /> radon <br /> Covered: ❑ Yes ❑No �„al <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: rl C l ✓� '4- <br /> Depth to Water: n' <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: s <br /> Casing Type: <br /> D(Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of 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 Ceme 47 b Water Cement 94 lb <br /> allons Ba gall ons Bags <br /> Thickest Thinnest aBags Thickest Thinnest xBags 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 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 /> I� 1i� N,S 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 />