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SAN J OA Q U I N Environmental Health Department <br /> Ureotness grows here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : 22- 2U Ins ector , J�lJl401% <br /> �''1 CONSTRUCTION <br /> Facility Address : v <br /> Well Address : Total Depth : <br /> WP # Q ,r� ,rj _Well # : Drilling Rig Type : <br /> Soil Bor nig <br /> Min 2 " Annular EHD Seal Verified : ❑ Yes ❑ No <br /> Drilling Company : —doh �t-olo� 1'lV � 12� J1 <br /> Driller Onsite : ri 11% /� C�J�'V �L,es Screen Length From : To : <br /> Consultant : P1� (DH <br /> Filter Pack From : To : <br /> Bentonite From : To : <br /> Geologist : ,)es_ i C& - <br /> Grout From : To : <br /> Public Water System Onsite : ❑ Yes ❑ No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No casing <br /> If yes , location and distance : height <br /> 4n <br /> SAMPLING xsov;`-GROUND CHRISTY_N <br /> Holding Temperature : GONFLEf{ON COMPLE o <br /> Method : GmrdScxfacs <br /> Screening Method : aft <br /> Verified Chain of Custody : ❑ Yes 1771 No ft• <br /> ft. <br /> ft. <br /> SPOILS ,- <br /> d <br /> Contamination Noted : ❑ Yes El No m <br /> C <br /> If yes , spoils storage Location : <br /> Covered : ❑ Yes El No <br /> If yes , material : <br /> GROUTING or DESTRUCTION - Total Depth : - - L - - _ - - - -.! - - - - - <br /> Depth to Water : n• — n• <br /> Grout Material : MATERIALS/ DEVELOPMENT <br /> Gallons of Grout Used : 9A Vo r <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction � � � Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation Boring Destruction Bags iz Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> ❑ Pressure Grout ❑ Over Drill Type/ Brand of Bentonite : <br /> Filter Pack Type/Size : <br /> Ck ,Gravity ❑ Tremie ❑ Other : Type of Method : <br /> Water ment 471 Water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest ttB Thickest Thinnest # Bags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> 15 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2047 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2082 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 7 35 70 7 <br /> 20 40 1 8 40 80 8 <br /> 10/ 16/2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464- 0138 www . socehd . com <br />