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SAN JOAQUIN Environmental Health Department <br /> ---COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> 4 Date:C_7� Ipector: / CONSTRUCTION <br /> Facility Address: ('' w 2 <br /> Well Address: Total Depth: Q <br /> WP#©O Well#: Drilling Rig Type: p �✓' <br /> Soil Boring#: <br /> Drilling Company: -1e�CMin 2"Annular EHD Seal Verified: El Yes []No <br /> Driller Onsite: _ � � Screen Length From: To: <br /> Consultant: �P;4/G�oyl <br /> Filter Pack From: To: <br /> Geologist: L-'-G Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 0 N COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING Agpyg.GgpUNp <br /> Holding Temperature: COMPLETION CCOM 4 EnoN <br /> Method: Ground Surtaws <br /> Screening Method: Gly <br /> Verified Chain of Custody: ❑ Yes El No -`--n' <br /> tt. <br /> tt. <br /> SPOILS k <br /> Contamination Noted: ❑ Yes El No a" <br /> If yes,spoils storage Location: slotted '' <br /> saedan <br /> Covered: ❑ Yes ❑No = gra„vil pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �'C __ <br /> Depth to Water: S✓� n- n' <br /> Grout Material: 6k�� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> e: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation`4Boring Destruction Slot Size: <br /> 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 C ftremie ❑Other: Type of Method: <br /> Water Cement I Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest zBags Thickest Thinnest t►Bags Bentonite/Cement Mix 3% Mix 3% 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 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 /> 13 ��f 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 />