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SAKJOAQUIN Environmental Health Department <br /> . `; <br /> --COUNTY---- <br /> Greatness <br /> —COUNTY -Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: qlA?o Inspector: �joC��v1G. CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# 1i e 1141 Drilling Rig Type: <br /> Soil Boring#: 2 ('� 13 <br /> in 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: C'I . S >r � �o"AOtM <br /> Driller Onsite: r-lo Screen Length From: To: <br /> Consultant: C:jurtryA cleeKol Filter Pack From: To: <br /> Geologist: -S e Ott <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes L1 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: COMPLETION COMPLETION <br /> Method: GroundSudw* T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: slotted <br /> s*cJon <br /> Covered: ❑ Yes ONO = 9, 61 Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 25�7 <br /> Depth to Water: ' no WCLVKft. <br /> Grout Material: rya eetlCQ/'1h. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:-'?5j yC) <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> goring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity �ZTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 11 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 73 35 1 70 7 <br /> 20 40 40 1 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 />