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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> y�Gcosn+:P' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: _ Inspector: fill CONSTRUCTION <br /> Facility Address: Z 5DD /V 14J L)g <br /> Well Address: Total Depth: <br /> WP# W 37q ff/ Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company Min 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: ✓1 Screen Length From: To: <br /> Consultant: IcAeY , lyle Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes KNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes QNo casing <br /> If yes, location and distance: height <br /> .W7T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION cGOMPtenoa <br /> Method: Ground Sudan <br /> Screening Method: a�«n <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft. <br /> ft. <br /> SPOILS = . <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: atoll <br /> aeon = B <br /> Covered: ❑ Yes El No = g-w+Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: lam . <br /> Depth to Water: 15 n- tt' <br /> Grout Material: Nect-f ( evvie; <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Sorin Installation Slot Size: <br /> g Boring Destruction Bags of 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 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest it Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix S% 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 40 8 40 80 8 <br /> �7J�(1,�Ur1 j71bS 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 />