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SAN;JOAQUIN <br /> Environmental Health Department <br /> --COUNTY <br /> Greatness grows here. <br /> ij <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Ins ector:� �I� � CONSTRUCTION <br /> Facilitress:Address: <br /> Well Address: Total Depth: ���/ <br /> WP# Q Well#: Drilling Rig Type: 6 <br /> Soil Boring#: 41 <br /> Drilling Company Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: A Screen Length From: To: <br /> VConsultant: yt Filter Pack From: To: <br /> Geologist: "r— Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT height <br /> —Ef WT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO(FLETION coMP1.EnoN <br /> Method: Ground Surra. <br /> Screening Method: groLA <br /> Verified Chain of Custody: ❑ Yes El No —` n' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: stoned ' <br /> on <br /> Covered: ❑ Yes ❑No = gnive, <br /> If yes, material: <br /> GROUTING or DESTRUCTION alepth: <br /> Depth to Water: 0L0/04;2 tt• tt. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 1 Casing Type: <br /> ❑Well Installation ❑Well 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Bag Rallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% 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 /> -42 a q �ayS 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 />