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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> t;,eotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> �l <br /> Date: 0 GInspector:- c)"()(AS CONSTRUCTION <br /> Facility Address: O r <br /> Well Address: ' Total Depth: <br /> WP#S�1 Well#:15t— <br /> Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <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: Iff—T <br /> height <br /> —EWT <br /> SAMPLING ABOV6GRCIUND <br /> CX)MPLETION CO <br /> Holding Temperature: COMPLETION <br /> Method: G=ndsuixs �— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑No —n <br /> —n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> f 0 3 <br /> slatted �i <br /> aactlon <br /> Covered: ❑Yes ❑No <br /> If yes, material: �y <br /> GROUTING or DESTRUCTION Total Depth: ?; <br /> DepthtoWater: tt. — n. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation XWell Destruction Blank Feet Screen Feet <br /> ❑Borin Installation , Slot Size: <br /> g ,,fiGt,,, soring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity I `rremie ❑Other: Type of Method: <br /> Water men[9716 Water Cement 941b <br /> allons Rallons Baits <br /> Thickest Thinnest #B Thickest Thinnest #Bags Bentonitelcement Mix 3%Mix 5%Mix_ <br /> 2.5 5 1 5 10 1 113entonite per47lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonlle per 94 lb 2A21 4.7 <br /> 7.5 is 3 15 30 3 <br /> 30 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />