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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY----Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 4Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: M Total Depth: 3� <br /> WP# 410 3"77 -yZ Well#: Drilling Rig Type: <br /> Soil Boring#: • -- <br /> y,r Min 2"Annular EHD Seal Verified: El Yes []No <br /> Drilling Company: <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 ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes 11 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND CHR_ <br /> Holding Temperature: COMF°t.ET{ON CCMPLEnoN <br /> Method: Ground Suri"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �.ft. <br /> it. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: atoa = - B <br /> soon r — <br /> Covered: ❑ Yes 11 No = graw+vack <br /> If yes, material: <br /> r <br /> GROUTING or DESTRUCTION Total Depth: -3® <br /> Depth to Water: 171, tt. <br /> Grout Material: V)CA*-- C <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> g [Boring Destruction 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 [Cremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest VBags Thickest Thinnest aBags 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 1 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 />