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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY....._.._..... <br /> �C9JLiFo Greatness grows here. <br /> Monitoring /W) ell/Soil Boring Inspection Report <br /> Date: Inspector:` OL-rt Q- H CONSTRUCTION <br /> Facility Address:2-7-550 1A1 Ke uAnt., ('V) <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#:wat <br /> Drilling Company: t Min 2" Annular EHD Seal Verified: E] Yes []No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION COMPPLEnoN <br /> Method: Ground Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes E]No —`--n' <br /> n. <br /> n. <br /> SPOILS 1 <br /> Contamination Noted: ❑ Yes ❑No J• <br /> If yes, spoils storage Location: b �` t slotted <br /> n <br /> Covered: ❑ Yes ❑No `/f 5 , 2S _ <br /> � <s_ — craw+pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 66 7 • __ <br /> Depth to Water: 6 0n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: o-' <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags 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 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 8 40 80 8 <br /> Q< ya'l Z 1 10/16/2017 <br /> ljSon, <br /> 1868 E. Hazelton Avenue California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />