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or 61—c <br /> S Q N.J OQ Q U I N Environmental Health Department <br /> —COUNTY— <br /> L',4i 'J Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> vim' <br /> Date: ( �[ r In pector: / CONSTRUCTION <br /> Facility Address: 49--"15 <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> - Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: <br /> Driller Onsite: •z. Screen Length From: To: <br /> Consultant: � C) ,� Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: COi4FLE ION COMPLETION <br /> Method: Ground$1 dacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �it. <br /> ts. <br /> R. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No =" <br /> If yes,spoils storage Location: <br /> slotted _ c <br /> atclon — 8 <br /> Covered: ❑ Yes ❑No = I <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: • _= <br /> Depth to Water: r t ft• _ tt. <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 Installatio Ing Destructi(Lj <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑PressureGrout ❑OverDrill 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 izallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest pBags 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 35 7 35 70 7 <br /> 40 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 />