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� _. . �e•ouiti <br /> SAN JOAQUIN <br /> Environmental Health Department <br /> -COUNTY— <br /> �"I, Greatness grows here. <br /> /1–7 Monitoring Well/Soil Boring Inspection Report <br /> Q <br /> Date: O 7 Z0 Inspector: C CONSTRUCTION <br /> Facility Address: t� � G ' 7 <br /> Well Address: Total Depth: {J <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: 0?--y Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: ,moo <br /> Driller Onsite: T 'Le--I Screen Length From: To: <br /> Consultant: 67e— Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <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 /> SAMPLING ABOVE-GROUND CHRISTY_ <br /> Holding Temperature: COhPLETION CCOAPLEnoisl <br /> Method: G=nd surfaos <br /> Screening Method: arl«rt <br /> Verified Chain of Custody: ❑ Yes El No —`--n' <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: abtvd <br /> sac9on — 3 <br /> Covered: ❑ Yes ❑No <br /> gravel pads <br /> If yes, material: QQ <br /> GROUTING or DESTRUCTION Total Depth: -l� S — <br /> Depth to Water: o j(� <br /> tt. = 1 IFft. <br /> Grout Material: <br /> Gallons of Grout Used: j MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction '� �� Blank Feet Screen Feet <br /> Slot Size: <br /> TBoring Installation El Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity PKremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bas gallons Bags <br /> Thickest 1nnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 Z, JS 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 1 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />