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SAKJ0A0UIN Environmental Health Department <br /> "' COUNTY— <br /> cy� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 0—V Inspector: o CONSTRUCTION <br /> Facility Address' f <br /> Well Address: 4'g Total Depth: '30 <br /> WP#AQ95 7 7 3 3 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company! <br /> Driller Onsite: G- ,,,� Screen Length From: To: <br /> Consultant: A e Filter Pack From: To: <br /> Geologist: <br /> 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 comPL noN <br /> Method: Ground Surf=* <br /> Screening Method: or�— <br /> Verified Chain of Custody: El Yes ❑No tt. <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: �to�ad = . <br /> an <br /> Covered: ❑ Yes []No w = graw+pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION otal Depth: <br /> Depth to Water: <br /> Grout Material: Cern <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> []Boring Installation Poring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity �•Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest sBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 3% 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 1 30 6 30 60 6 <br /> 17.5 1 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 1 www.socehd.com <br />