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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> CJJ 1J <br /> onitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: \ V5 yl . Total Depth: <br /> WP# -yA) ­�A Y\1. Well#: \ Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: \1WQt,�1lnQ7JV'iJ'9 Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> g ���J��QN�VCWa Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 4N COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes N0 casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CANPLSnON COMP�_LETiON <br /> Method: ornundsufacs + <br /> Screening Method: araft <br /> Verified Chain of Custody: ❑ Yes El No <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No k = <br /> If yes,spoils storage Location: stonad ' s <br /> sacdon �'° = 3 <br /> Covered: ❑ Yes ❑No <br /> 9mf Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 29� <br /> Depth to Water: _ n• <br /> Grout Material:Thi �k���t <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> []Well Installation WWell 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 WTremie []Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest riBags Bentonite/Gement 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 /> l0 20 4 20 40 4 <br /> 12.5 25 5 25 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 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 www.socehd.com <br />