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�aPp <br /> f= r �z SA KJ U I N Environmental Health Department <br /> `i —COUNTY- <br /> 4cR � Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 9//i/lam Inspector: CONSTRUCTION <br /> Facility Address: 12SoDove_ '7,rve i2—yLA �1�k <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: 1n,�d� �fit� G4, T�,� Min 2"Annular EHD Seal Verified: 11 Yes ❑No <br /> Driller Onsite: hi"' oek <br /> 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GRMND <br /> Holding Temperature: COMPLETION comPP EnON <br /> Method: Ground Surfaxs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes []No �ft. <br /> fi. <br /> ft. <br /> SPOILS . <br /> K = o <br /> Contamination Noted: ❑ Yes ❑No ` <br /> If yes,spoils storage Location: slottna <br /> mon <br /> Covered: ElYes ❑No <br /> Q-Vw tack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: L1,1 '— <br /> Depth to Water: `I Qln- n' <br /> Grout Material Keai MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: rem 76 <br /> Casing Type: <br /> ❑Well 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags 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 /> s 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 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 />