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SAN JOAQUIN <br /> N. =� Environmental Health Department <br /> COUNTY- <br /> Greatness <br /> OUNTY- <br /> Greatness grows here. <br /> 2Moniitoring /Well/Soil Boring Inspection Report <br /> Date: ✓ 0spector: iAk' a'/ 1 ' II CONSTRUCTION <br /> Facility Address: %1 N <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: 1 65 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: frA--Z&-n SSe a <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: L 064 Filter Pack From: To: <br /> Geologist: ;(/t h 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 CCP�LETION <br /> M <br /> MMethod: °round Surface <br /> Screening Method: '�_ ff__ '' ori <br /> Verified Chain of Custody: El Yes El No D l ; 2 61 Ile- fltI'I�ICc� —n' <br /> n. <br /> u I ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No �j?j• 2 I I <br /> If yes,spoils storage Location: u a 6 IAC tlr�itao = s <br /> 6 <br /> 1 ,t�cion 3 <br /> Covered: El Yes ❑No g-viW pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:—RLP V. =_ <br /> Depth to Water: n' — n' <br /> Grout Material: <br /> Gallons of Grout Used: too MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation'9Boring 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 Cement 71b Water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 11 Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.s 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 40 8 40 80 8 <br /> 1p / 10/16/2017 <br /> 1868 E. l4azelton Avenue II Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />