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SAN`��QQ (`' Environmel I Health Department <br /> —COUNTY— <br /> . , <br /> S: Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector- CONSTRUCTION <br /> Facility ddre s: <br /> Well Address: &- / Total Depth: <br /> WP# 0 3 Well#:bDrilling Rig Type: �n,�(` t�1� - CS <br /> 4 <br /> Soil Boring#: �i <br /> Drilling Company: t Min 2"Annular EHD Seal Verified: El Yes I;lo Z =>C' tIt <br /> Driller Onsite: Screen Length From: To: nom . <br /> Consultant: L Filter Pack From:i To: lo' 4 _ `' <br /> Geologist: 1�24 J,.., (_�HYD Bentonite From:IQ %4 To: <br /> 1 Grout From: :1 To,������ <br /> Public Water System Onsite: El Yes ❑No COMPLETION El Stove Pipe Chrl� istie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> W- T �T <br /> SAMPLING ABOVE-GROUND <br /> CowLETION C}iM -BOX <br /> Holding Temperature: conaPtPLE�rioN <br /> Method : Ground SWacs <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes ❑No ft- <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes,spoils storage Location: <br /> sac.on = <br /> Covered: ❑ Yes ❑No <br /> 71�w Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: . <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bag gall ons Bags <br /> Thickest Thinnest riBags 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 s0 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 I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 I, www.socehd.com <br />