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SANi>JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z �Z� Insp tor: A r'(b' CONSTRUCTION <br /> Facility Address: -Qxy'• <br /> Well Address: Total Depth: O <br /> WP#(!)o `15-oaq Well#: MtAl-1 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: {N tt'K Min 2" Annular EHD Seal Verified: M Yes ❑No <br /> Driller Onsite: aw/ke Screen Length From: To: 3p1 <br /> Consultant: 135K Filter Pack From: To <br /> Geologist: A40�let0 Bentonite From:,_ To: <br /> Grout From: Z 31 To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe AChristie Box <br /> Domestic Well Onsite: ❑ Yes ❑Now l casing <br /> If yes, location and distance: l j� I� height <br /> SAMPLING A130VE•GROUND <br /> COMPLETION CKIO <br /> Holding Temperature: COMPLETION <br /> Method: Orouna s0nao. -� <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No —tt <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No =_ " <br /> If yes, spoils storage Location: alonad 2 c <br /> I _ 8 <br /> Covered: ❑ Yes ❑No wctlon <br /> — <br /> If yes, material: <br /> t <br /> GRol lnniC or DESTRUCTION Total Depth: <br /> Depth to Water: s tt. <br /> Grout Material: c <br /> � MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 7-5 <br /> y,TJI"i Casing Type: 'R✓G.,.q-fit/O <br /> ❑Well Installation ❑Well Destruction Blank 7_Feet Screen _ Feet <br /> An"'5L Woring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonl� -3/17 <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: f2 <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water Cement 471b Water cement 941b <br /> atlons Bags stations Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% MIX <br /> 2.5 5 I 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 4.7 <br /> 7.5 is 3 15 30 3 <br /> to 20 4 20 40 4 <br /> Us 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 3s 70 7 <br /> 20 40 8 40 80 8 <br /> 'N KS 10/16/2017 <br /> M1j` <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.socehd.com <br />