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SAN10QgUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: U 7, 1,� Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: <krbte.r Total Depth: <br /> WP# `\ Well#: Drilling Rig Type: <br /> Soil Boring#: L.Q <br /> Drilling Company: ,�y,� �� . Min 2"Annular EHD Seal Verified: El Yes El No <br /> g p y: t�+�t o . <br /> �O�b`'� Screen Length From: To: <br /> Driller Onsite: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: t6es ❑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: COhFLffnON ccOwLEnoN <br /> Method: c3=ndSufacs + <br /> Screening Method: gra,t <br /> Verified Chain of Custody: ❑ Yes ❑No ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r <br /> If yes,spoils storage Location: slatted <br /> ssc,on <br /> Covered: ❑ Yes ❑No =_ 9-101 <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: \vO =_ <br /> Depth to Water: ' <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑ ll <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 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Gement Mix 3% Mix 5% Mix <br /> 2.5 s 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s QDO 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 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 17 35 70 7 <br /> 20 40 1 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 />