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SANJOAQUIN Environmental Health Department <br /> " f COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: t} Inspector: UUj CONSTRUCTION <br /> Facility Address: I � j _ � <br /> Well Address: Total Depth: <br /> WP# 26(blN11W(D Well#: I Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: C'�(*luwlc <br /> Driller Onsite: _11a-, 6 Screen Length From: To: <br /> Consultant: �� <br /> Filter Pack From: To: <br /> Geologist: 1040N S. 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: 11,J1 <br /> height <br /> SAMPLING Agpyg.G,RpUNp <br /> Holding Temperature: COMPLETION CC _OMPLEnCN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —`----n. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = m <br /> If yes, spoils storage Location: sfottQd <br /> on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> 77�� r• _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: Nf at OXW� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: t5 O Dry <br /> Casing Type: <br /> ❑Well Installation Awell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method. <br /> Water Cement 471b Water Cement 941b <br /> gall Bags gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 1:Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 40 80 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 />