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� QU'" � z SAN JOAQUIN <br /> Environmental Health Department <br /> k .. COUNTY <br /> `gciFoa? Greatness grows here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : Inspector : 'Ie�` CONSTRUCTION `3 : Glomi . <br /> Facility Address : pfur ioliie oga *ro <br /> Well Address : Total Depth : <br /> WP # y/ Ll Well # . Drilling Rig Type : <br /> Soil Boring# : 3 (f cZmoor. �f'—�c Min 2 " Annular EHD Seal Verified : El Yes ❑ No <br /> Drilling Company : 6Cs4aWC <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : �S Filter Pack From : To : <br /> Geologist : Lsvnw/l <br /> 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 : height <br /> W7:F <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature : COMPLEN cot PLEno_N <br /> rlO <br /> Method : Grand Surface <br /> Screening Method . grout <br /> Verified Chain of Custody : ❑ Yes El No 4 ft' <br /> ft. <br /> ft. 49 <br /> SPOILS = <br /> Y O <br /> Contamination Noted : ElYes ❑ No '° <br /> If yes , spoils storage Location : stood <br /> saclon ' <br /> Covered : ❑ Yes ❑ No = . <br /> vivo' Pack <br /> If yes , material : <br /> GROUTING or DESTRUCTION Total Depth : <br /> Depth to Water : <br /> Grout Material : A, 1 eelowko.� <br /> Gallons of Grout Used : Z Z • Z • MATERIALS/ DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> ��,, <br /> ❑ 21/ <br /> Slot Size : <br /> Boring Installation 21Boring Destruction Bags Sizes <br /> Cement : <br /> METHOD USED Bags Sand / Gravel : <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill <br /> Filter Pack Type/Size : <br /> ❑ Gravity E! Tremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Faallons Bags <br /> Thickest Thinnest uBags 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 /> T5 15 3 15 30 3 <br /> 10 1 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 8 1 40 80 8 <br /> 10/ 16 / 2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 1 F 209 464- 0138 www . socehd . com <br />