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SAN JOAQUN <br /> —COUNTY-- <br /> Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: / ' Inspector: C CONSTRUCTION <br /> Facility Address: V d�,/ W b+ 05A <br /> Well Address: Total Depth: <br /> WP# OUMT30Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: El Yes ❑No <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: COWLETION COMPLEMN <br /> Method: Ground Surf ac* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes Ll No •�--tt' <br /> tt. <br /> tt. <br /> SPOILS k=. <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: abs <br /> :s = <br /> a�cson r _ <br /> Covered: ❑ Yes ❑No = gravW pack <br /> If yes, material: ` <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt• tt' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation '❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation 415oring 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 /> 71ravity ❑Tremie ❑Other: Type of Method: <br /> Water Fent 471b Water Cement 941b <br /> allons f Bas gall ons Bags <br /> Thickest Thinnestags Thickest Thinnest nBags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.s 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 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 s 40 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 />