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SAN-J OAQ U I N Environmental Health Department <br /> COUNTY <br /> Greatness Grows he c. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 'r Inspector: Sf — CONSTRUCTION <br /> Facility Address:/6ds/fo A( ;Z77 <br /> Well Address: Total Depth: <br /> WP#!'O g ff-7.7 Well#:Aw Iwo Drilling Rig Type: <br /> Soil Boring#: <br /> � Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: �' <br /> Driller Onsite: ��Y Q Ati Screen Length From: To: <br /> K G Filter Pack From: To: <br /> Consultant: C <br /> Geologist: � d�/&'Qw Bentonite From: To: <br /> Grout From: 2SO' To:—,'4 7-rlz'?(. <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING ABOVE-cRCUND <br /> Holding Temperature: CONFLION cce{NPLEncN <br /> ET <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> tt. <br /> ft. <br /> SPOILS <br /> a <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes, spoils storage Location: slotted <br /> on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: : <br /> GROUTING or DESTRUCTION Total Depth: t�06 <br /> Depth to Water: n• n' <br /> Grout Material: N it f un%tK* <br /> Gallons of Grout Used: I" MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> MWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑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 WTremie ❑Other: Type of Method: <br /> ater ce(nt 71 Water Cement 941b <br /> allons) a gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%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 S 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 /> 0 i 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />