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SAN. JOAQUIN Environmental Health Department <br /> ` ---COUNTY--- - ZGII V1 <br /> cS:�vear.' Greatness grows here. �f�i�CC� 10 <br /> Monitoring Well/Soil Boring Inspection Report ' u01 <br /> Date: 2\ 1 Ins ector:�� CONSTRUCTION <br /> Facility A dcf rens: <br /> Well Address: Total Depth: <br /> WP# QC Well#: Drilling Rig Type: <br /> Soil Boring#: cwz <br /> `\ Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: 1 T1 <br /> Driller Onsite: b`@K Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: 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 ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND _ <br /> Holding Temperature: COMPLETION cicf. .E7tON <br /> Method: around Sudwit <br /> Screening Method: al«t <br /> Verified Chain of Custody: ❑ Yes El No —`---n' <br /> tt. <br /> ft. <br /> SPOILS = <br /> = o <br /> Contamination Noted: ❑ Yes 0 N — <br /> If yes,spoils storage Location: Sion d <br /> action _ B <br /> Covered: ❑ Yes ❑No _ anvl+Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total <br /> Depth: <br /> Depth to Water: �p►put�Y n• ft' <br /> Grout Material: Pllk MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: kO O <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation (98oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> []PressureGrout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest &Bags Thickest Thinnest NBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 V 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 1 30 6 30 60 6 <br /> 17.5 1 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 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />