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SANJOA UIN <br /> r Q Environmental Health Department <br /> —COUNTY— <br /> Greatness groves here. <br /> /l Monitoring Well/Soil Boring Inspection Report <br /> Date: ! 2/ 6 Ins ector: CONSTRUCTION <br /> Facility Address: /# <br /> Well Address: Total Depth: Z Z� (9 () / <br /> WP# bro Well#: t— Drilling Rig Type: <br /> Soil Boring#: cl Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: a._s C <br /> Driller Onsite: J9 y ,yyyp Screen Length From: To: <br /> Consultant: S^Pp.,.,—�P ( Filter Pack From: To: <br /> Geologist: V�3-A Bentonite From: To: <br /> `� <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes,location and distance: height ' <br /> SAMPLING ABOVE-GROUND CHRMN-Box <br /> Holding Temperature: °OWLET1ON COMPLETION <br /> Method: Orourd Suiac. <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —`--n' <br /> —n. <br /> n. <br /> SPOILS <br /> 7 a <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: awnaa ` <br /> secEon 3 <br /> Covered: El Yes ❑No = a-wPack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:�� <br /> Depth to Water: n• �tt' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installationpkoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> +��t,,,fff___ Filter Pack Type/Size: <br /> �a,t❑ Gravity remie ❑Other: Type of Method: <br /> Water / Cement 471b Water Cement 941b <br /> allons Bags stations Bags <br /> Thickest Thinnest Bags Thickest Thinnest #Bags _ BentonitelCement Mix 3% Mix 5%Mix <br /> 2.s 1 5 10 1 Bentonite or 47 lb 1 Al 2.47 <br /> s Io 2 10 20 2 Bentonite per 941b 2.82 4.7 <br /> 7.5 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 8o 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 />