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SAN.JOAQUIN Environmental Health Department <br /> —C.O U N T Y— <br /> Grea"ness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: \� IV Inspector: pa�N �. CONSTRUCTION <br /> Facility Address: <br /> Well Address: ?;"10 10 "\(\WC Total Depth: <br /> WP# A-\XY Well#: 1 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: t Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 1_ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes yR,N0 COMPLETION El Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: El / \Yes J No caning <br /> If yes, location and distance: WT height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION c�OWLEETioN <br /> Method: GmndSW'c' <br /> Screening Method: a�«t <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> fi. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r' <br /> If yes,spoils storage Location: slotted <br /> sacdon <br /> y� <br /> Covered: ❑ Yes ❑NojEi.= , I <br /> ck <br /> If yes, material: ` <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: " ' <br /> Grout Material: N tPN L <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 Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity VkTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 1s 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> r 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 6 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 />