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2 P SAN�,JOAQUIN <br /> Environmental Health Department <br /> " a COUNTY <br /> `c9r, Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �� Z 2-0 inspector: &Kh rpt CONSTRUCTION <br /> Facility Address: UiL6:��— . H "H S L <br /> Well Address: Total Depth: /I <br /> WP# (9 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> � ►'(q p,-�� Filter Pack From: To: <br /> Consultant: <br /> � , (' <br /> Geologist:_ -jD 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: COt"F�ION GOOMPLETnoN <br /> Method: G=nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> tt. <br /> tt. <br /> SPOILS = <br /> 1z' a <br /> = o <br /> Contamination Noted: ❑ Yes El No <br /> C <br /> If yes,spoils storage Location: slotted <br /> 2-5 &aeon = B <br /> prs�rsl pads <br /> Covered: El Yes ❑No = <br /> If yes, material: D6 -30 x = <br /> z <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ct, <br /> Grout Material: NI&L-f a rYIQ <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installationoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity 'ZTremie ❑Other: Type of Method: <br /> Water tement 471b Water Cement 941b <br /> gall s Bas gallons Bags <br /> Thickest Thinnest s Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 3% 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 /> 1 t 5 W X94{ Gv��.# �" iy�f G 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.socehd.com <br />