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• ��ornujN�.. <br /> SANJOAQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> �j Monitoring Well/Soil Boring Inspection Report <br /> Date: l Inspector: ILfzoi, s, CONSTRUCTION <br /> Facility Address: ( V <br /> Well Address: R;�i;r 10.,1 �,'� ,�,} �" f��+, � ! �v Total Depth: <br /> WP# r'Q Kn S Well#: Drilling Rig Type: <br /> Soil Boring#: (F _ Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: rr 4,: - Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: <br /> n/�tn�,y1,s,/ Filter Pack From: To: <br /> ,/h <br /> Geologist: 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 1:1 No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: OONFLET1ON COMP�LET1oN <br /> Method: Ground Sumac* <br /> Screening Method: Q.out <br /> Verified Chain of Custody: ❑ Yes ❑No -n <br /> ft. <br /> n. <br /> SPOILS =_ <br /> k. <br /> O <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: abnod <br /> sac�on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: _- <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: I to Vii►,z } MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size: <br /> 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 V]Tremie ❑Other: Type of Method: <br /> ater C en t 4 b Water Cement 941b <br /> Ra <br /> ons s allons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest ttBags 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 1 25 5 25 50 5 <br /> 15 1 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />