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SANIJOAQUIN—COUNTY— <br /> Environmental Health Department <br /> Greatness grows here. <br /> ��/yy,, Monitoring Well/Soil Boring Inspection Report <br /> Date: I� Z !ir/ Ins ector: G CONSTRUCTION <br /> Facility ddress: Z 4o'<�6L r I , <br /> Well Address: Total Depth: s t <br /> WP# O0 t Well#: Drilling Rig Type: ZS f 4' <br /> Soil Boring#: b I (Sg' K� j(LLp <br /> Drilling Company: It C�g' in 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: creen Length From: To: <br /> Consultant: ✓G °!' SSD4` S Filter Pack From: To: <br /> Geologist: SC_ Bentonite From: To: <br /> �l 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 GG <br /> Asove 33atxmo rHgtsT1•Box <br /> Holding Temperature: oohrLEr1oN compLsnoN <br /> Method: Groinds + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes El No <br /> _ft n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: atoned <br /> sacdonF = 3 <br /> Covered: ❑Yes ❑No = g-9lack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:—' [`r' <br /> Depth to Water: N t <br /> Grout Material: 0 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:_ �j� <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slat Size: <br /> ❑Boring Installation oring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity emie ❑Other: Type of Method: <br /> Water Cement 4716 Water Cement 94lb <br /> allons Bags ealions Bags _ <br /> Thickest jNnnest pBags Thickest Thinnest #Bags _Bentonite/Cement MIX m Mix 5%Mix_ <br /> 2s s 1 5 10 1 Bentonite per 47 lb 1.41 %4.7 <br /> 5 l0 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 30 <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 />