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SAN JOAQUIN Environmental Health Department COUNTY-grows here. <br /> p Monitoring Well/Soil Boring Inspection Report <br /> Date: L Inspector: CONSTRUCTION <br /> Facility Address: 30(0 b - un Lnictt <br /> Well Address: Total Depth: <br /> WP# S Well#: Drilling Rig Type: <br /> Soil Boring#: Z. 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: ,��w, 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: � height <br /> _CWT <br /> SAMPLING ABOVE-GROUND <br /> COWLETION COMPLE-BOX <br /> Holding Temperature: cornr�EnoN <br /> Method: Ground su lass + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> n. <br /> SPOILS <br /> 0 <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: S /� ��, •!, _ B <br /> Q 1 sac�on 1j <br /> Covered: ❑Yes ❑No /5 _ wavalvack <br /> If yes, material: [R r 3 <br /> GROUTING or DESTRUCTION Total Depth: Df ' �(/�d <br /> Depth to Water: ND vgWek ffflll��w tt. = tt. <br /> Grout Material: N e« ce <br /> Gallons of Grout Used: 3O. 3 e, 30_. '3 Q2ct /6_S MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation koring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type Brand Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> e/Size: <br /> KGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> cations Bags allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 941b 2.82 4.7 <br /> 7.5 15 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 /> 10 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 />