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SAN. JOAQUIN <br /> Environmental Health Department <br /> - <br /> COUNTY---- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> '�/Date: �� Inspector: aI' t D� CONSTRUCTION <br /> FacilityAddress: <br /> Well Address: Total Depth: <br /> WP# L)L40 S io Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: q'0 L-4,Q Filter Pack From: To: <br /> Geologist: i I'I 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 L1 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLEnON CCOMPPLEnOON <br /> Method: Ground Surf=* <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> tt. <br /> SPOILS <br /> r = - a <br /> Contamination Noted: ❑ Yes E]No r" <br /> If yes, spoils storage Location: atoll <br /> 2 s�e3on r — <br /> Covered: ❑ Yes ❑No ; J %' <br /> flrawl pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: A <br /> Depth to Water: <br /> tt. = tt. <br /> Grout Material: <br /> Gallons of Grout Used: ti MATERIALS/DEVELOPMENT <br /> It 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 /> �I Gravity By4remie ❑Other: Type of Method: <br /> Water Cemen Llb Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 1 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> /3 � 7� 10/16/2017 <br /> 1868 E.telton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />