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zP" c SANdOAQUIN <br /> Environmental Health Department <br /> —COUNTY <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I ZOZInspector:�a�nc•J lu le'+T: ��:, -� CONSTRUCTION <br /> Facility Address: <br /> Well Address: h Total Depth: <br /> WP# (9lD PLL ell#: Drilling Rig Type: Com/ <br /> Soil Boring#: KA <br /> Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: l,Sxo1���L'nh <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: �.L� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes L1 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND CHR__ <br /> Holding Temperature: COMPLETION ODMPLETION <br /> Method: G=nd Suiace <br /> Screening Method: a�«n <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> n. <br /> tt. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slatted <br /> soon <br /> Covered: ❑ Yes ❑No �} <br /> 9-VW paac <br /> If yes, material: =_ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: fL n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation l7Boring 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 XTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest tlBags 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 40 40 80 8 <br /> 't�34� 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 />