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SAN<JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z Inspector: k ,\Z CONSTRUCTION <br /> Facility Address: -MO E. IM9.) <br /> Well Address: Total Depth: <br /> WP# TADCd84 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: cunktuerut <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Rn d1RtSt10 Filter Pack From: To: <br /> Geologist: 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 /> SAMPLING ABOVEGROUND cHciIM-BOX <br /> Holding Temperature: COWLFTlON COMPLETION <br /> Method: G=nd svfac. + <br /> Screening Method: arl+o� <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ft. <br /> SPOILS u e <br /> Contamination Noted: ❑ Yes ❑No ° <br /> If yes,spoils storage Location: slotted = 8 <br /> aac5on }j <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: sl <br /> Depth to Water: <br /> Grout Material: NfA} GQ VVVI} MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: j�. <br /> 00 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 913oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ce ent 471b Water Cement 941b <br /> allons Ba s gallons sags <br /> Thickest Thinnest s Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 5 1 .' 5 to 1 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.82 4.7 <br /> 7.5 15 3 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 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 />