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SKJOAQUIN <br /> cv COUNTY— Environmental Health Department <br /> Greatness yro.rs he:e. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �o�u' Zp c Inspector: QH;Z CONSTRUCTION <br /> Facility Address: 21, SPu/�� °T�,, C41ii 4� <br /> Well Address: ��, Total Depth: <br /> WP# OL) 1-(j 3 18 Well#: Drilling Rig Type: <br /> Soil Boring#: I Min 2" Annular EHD Seal Verified: ❑ Yes 11 No <br /> Drilling Company: <br /> Driller Onsite: Z Screen Length From: To: <br /> Consultant: RMf} koSe.,'c+ue <br /> Filter Pack From: To: <br /> Geologist: Vin"t e H, Bentonite From: To: <br /> f 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 /> iii <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION cpnno <br /> oomt-• oN <br /> Method: Ground Surface <br /> Screening Method: oraA <br /> Verified Chain of Custody: ❑ Yes ❑No -�---n <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No _ <br /> If yes, spoils storage Location: abed <br /> B <br /> s�c9on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: /- <br /> GROUTING or DESTRUCTION Total Depth:-HL- p =_ <br /> Depth to Water: <br /> Grout Material: Ah,,4 �i,,,eA4 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 PJIBoring 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 ZOther: ,.. j Type of Method: <br /> Water Cement 471b Water Cemen41b <br /> allons Bas gallons Ba <br /> Thickest Thinnest uBags Thickest Thinnest uBags 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 /> 30 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.socehd.com <br />