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SAN JOAQUIN Environmental Health Department <br /> COUNTY--- <br /> , <br /> Greutr,ess grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: JAL" l Inspector: CONSTRUCTION <br /> Facility Address: "�� - ��/� t <br /> Well Address: Total Depth: <br /> WP# LSC/ S &CY L^4 Well#: Drilling Rig Type: � a S <br /> Soil Boring#: '— I Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: Oj f <br /> Driller Onsite: el-2:_0— = L Screen Length From: _ To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe L1 Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> � <br /> SAMPLING A BOVE.wGaouNo C+iRLSTY_ <br /> Holding Temperature: COWLETION COOMPtEnoN <br /> Method: G=ndS"rf'°' <br /> Screening Method: erg <br /> Verified Chain of Custody: ElYes ❑No �ft• <br /> ft. <br /> ft. <br /> SPOILS <br /> Ccntamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: abn�a <br /> an r = B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: �'P`�ILIv MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑BSlot Size: <br /> oring Installation ring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bas gallons Bags <br /> Thickest Thinnest nBags Thickest Thinnest J1 Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82F 4.7 <br /> 7.5 3 15 30 3 <br /> 10 0 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 _Jr40 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 />