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° v SAN JOAQUIN <br /> COUNTv Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:1p-M�f[ Inspector: N)hiAo& CONSTRUCTION <br /> Facility Address: t!d L /*k/ <br /> Well Address: Total Depth: <br /> WP# 240Wb4( Well#: '$' Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: -�'e4- Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: � le Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: ry: e% Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ONO casing <br /> If yes, location and distance: height <br /> SAMPLING A13OVE-GROUND <br /> COI.�LETION CNRISTYTIO <br /> Holding Temperature: COMPLETION <br /> Method: Gmndsunaes -T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Non• <br /> n. <br /> SPOILS n. <br /> e <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: slotted -_ <br /> Covered: El Yes ❑No section <br /> _ gnvwlack <br /> If yes, material: <br /> r <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: <br /> Grout Material: _;vW « MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: -70 b�l <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size:Baring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ressure Grout Dover 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 Bags stallons Baas <br /> Thickest Thinnest NBags Thickest Thinnest #Bags _ Bentonite/Cement MIX 8% MIX 5%MiX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> to 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 35 30 6 30 60 6 <br /> 17.5 35 7 35 70 1 7 <br /> 20 40 B 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 />