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� ` SAN JOAQUIN <br /> lOP N <br /> Environmental Health Department <br /> COU N T Y -- <br /> Greatness grows here . 3d'drw <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : 3 LZ 4? Inspector : CONSTRUCTION <br /> Facility Address : � .� f3 .i�-•c!, <br /> Well Address : Total Depth . <br /> WP # d?c ) q17// Well # : Drilling Rig Type : <br /> Soil Boring# : 69,oZW- 1,9100 <br /> Min 2 " Annular EHD Seal Verified : El Yes ❑ No <br /> Drilling Company : eGd e42L <br /> H Screen Length From : To : <br /> Driller Onsite : Z <br /> Consultant : Filter Pack From : To : <br /> Geologist : Bentonite From . To : <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 /> SAMPLING ABOVE-GROUND CHMM_ . <br /> Holding Temperature : COWPL.ETION COMPt.EMN <br /> Method : Ground Surface <br /> Screening Method . grout <br /> Verified Chain of Custody : ❑ Yes ❑ No n ' <br /> ft. <br /> tt. <br /> SPOILS — <br /> Contamination Noted : ❑ Yes ❑ No <br /> If yes , spoils storage Location : sb d <br /> socron = <br /> Covered . ❑ Yes ❑ No <br /> 7ZV'w Pack <br /> If yes , material : <br /> GROUTING or DESTRUCTION Total Depth : <br /> Depth to Water : � 7 <br /> "/v tt• <br /> Grout Material : 4i MATERIALS / DEVELOPMENT <br /> Gallons of Grout Used . <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation RBoring Destruction Slot Size : <br /> Bags of Cement : <br /> I METHOD USED Bags Sand / Gravel . <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑Over Drill Filter Pack Type/Size . <br /> El Gravity L�Tremie ❑ Other : Type of Method : <br /> I <br /> Water Cement 471b Water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest tt Bags Thickest Thinnest Bags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> 2 , 5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2047 <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 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 40 80 1 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 />