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'o'avW� <br /> $ANJOQQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: (s-#S—Nf Inspector: +sfar CONSTRUCTION <br /> Facility Address: GrE• /o.i4 'SA-0ef <br /> Well Address: Total Depth: <br /> WP# a'd97y® Well#: Drilling Rig Type: <br /> Soil Boring#: S>//_ ,rvt Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: Rpj.Mn .e ef [SSW <br /> DrillerOnsite: �2lee Screen Length From: To: <br /> Consultant: ^jvw .'e GeaGr.✓ Filter Pack From: To: <br /> Geologist: 4..o / L.zewa z can Bentonite From: To: <br /> ' Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: nsigne <br /> _(WT <br /> SAMPLING ABOVE-GROUND <br /> CONFLETION CF6i O <br /> rnaLETi <br /> lETi <br /> Holding Temperature: cooN <br /> Method: Ground suiac� �-- <br /> Screening Method: grIan <br /> Verified Chain of Custody: ❑Yes END L�a• <br /> SPOILS <br /> Contamination Noted: ❑ Yes ONO , o <br /> If yes,spoils storage Location: <br /> Covered: ElYes ONO .*cdcn <br /> ?S = <br /> If yes, material: y v/, Sv z (e 7 aR <br /> 7 <br /> GROUTING or DESTRUCTION Total Depth�j-iS <br /> Depth to Water: /3 Q/ .1 15 tt. — ><• <br /> Grout Material: .Nwr evow»if- <br /> Gallons of Grout Used: /:-5 /•S't- 3 _ MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation 19toring Destruction Slot Size: <br /> 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 /> ElGravity Bffremie EKOther: Al"4t' Type of Method: <br /> Water Cement 471b Water Cement 9411a <br /> allons Bags allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bag: _ Bentonite/Cement Mix 3%MIX 5% MIX <br /> 2 s 1 s la 1 Bentonite per 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 12.62 4.7 <br /> 7.5 15 3 15 30 3 r <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 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 />