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S A N J O A Q U I N Environmental Health Department <br /> -- COUNTY -- <br /> G I- eatne <br /> - COUNTY - <br /> GI- eutness 91 here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : �,1 Inspector : G�,iih _ CONSTRUCTION <br /> Facility A dress : s� J <br /> Well Address : �'O.UI Total Depth : <br /> WP #bD ?, ' Well # : Drilling Rig Type : <br /> Soil Boring# : # Min 2 " Annular EHD Seal Verified : ❑ Yes El No <br /> Drilling Company : <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : P6Xafu; Cvpj Tr) c <br /> Filter Pack From : To : <br /> Geologist : �� \iwowN <br /> Bentonite From : To : <br /> Grout From . To : <br /> Public Water System Onsite : ❑ Yes [I No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No casing <br /> If yes, location and distance : height <br /> SAMPLING Awvr=E GROUND <br /> Holding Temperature : COMPLETION COMPLETION <br /> Method : G=nd Surf " <br /> Screening Method . or«n <br /> act <br /> Verified Chain of Custody . ElYes El No —' n' <br /> fz. <br /> ft. <br /> SPOILS :4 <br /> Contamination Noted : ❑ Yes ❑ No Few01{ <br /> C <br /> If yes , spoils storage Location : atoI = <br /> sac9on sC <br /> Covered : ❑ Yes ❑ No = . <br /> ¢twat pack <br /> If yes , material : <br /> GROUTING or DESTRUCTION Total Depth : <br /> Depth to Water : ^- k5 - � fft' <br /> Grout Material : ng a nk MATERIALS/ DEVELOPMENT <br /> I Gallons of Grout Used : SAA, <br /> Casing Type . <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size . <br /> ❑ Boring Installation KBoring Destruction <br /> Bags of Cement : <br /> METHOD USED Bags Sand / Gravel : <br /> C Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill <br /> Filter Pack Type/Size : <br /> ElGravity &Tremie ❑ Other : Type of Method . <br /> Water Cement 47 lb Water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest # Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3 % MIX 5 % Mix <br /> j 2, 5 5 ✓ 1 ✓ s 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> s 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 30 6 30 60 6 <br /> 17. 5 35 7 35 70 7 <br /> 20 40 8 11 40 80 1 8 <br /> 10/ 16/2017 <br /> 1868 E . Hazelton Avenue Stockton California 95205 1 T 209 468 - 3420 F 209 464-0138 www . socehd . com <br /> J <br />