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�� SAN�JOAQUIN <br /> soP1 co <br /> Environmert.al Health Department <br /> CEaS�'y '� —COUNTY— <br /> sO9ro� Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report W `. <br /> Date: -�r Inspector: nest-4 - CONSTRUCTION <br /> Facility Address: s�o T.se( a4n'� / r4nc <br /> Well Address: Total Depth: <br /> WP ell#:IY-160 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: rd(r Le�y(e- Screen Length From: To: <br /> Driller Onsite: a Filter Pack From: To: <br /> Consultant:_ /� -1 O/ <br /> Geologist: Tt 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 El No casing <br /> If yes,location and distance: lff height <br /> SAMPLING AWVE-GAOUNE) ctwlsTreox <br /> H COWLETION COMPLEnoN <br /> Holding Temperature: <br /> Ground Suiac� <br /> Method: <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑Nott. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No lejl/>C x <br /> o <br /> If yes,spoils storage Location: / i tl°nid <br /> .acdon <br /> Covered: ❑ Yes ❑No _ grawl Pack <br /> If yes, material: Z ��ii .1rrY ��►� <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 4) tt' <br /> Grout Material: ewq` Y' MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 2 Ola to)" Casing Type: <br /> frWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie Srother: 'P"/7 Type of Method: <br /> Water cement 471b Water Cement 941b <br /> allons Bags allons Bags - <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags i8entonite/Cement Mix 3 0 MIX 5 0 Mix_ <br /> 2.5 s 1 s to 1 _ Bentonite per 47 Ib 1.41 2.47 _ <br /> 5 10 2 10 20 2 lBentonite per 94 Ib 1 2.821 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 1 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95206 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />