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I <br /> SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> �` Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 Inspector: .M CONSTRUCTION © pW� riIfed : U/ <br /> Facility Address: SVS1 ) "���j <br /> Well Address: Total Depth: bj F C1 <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: Pfnct— <br /> Driller Onsite: NVtw\ Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: A Bentonite From: To: <br /> Geologist: \ �� <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND CHPIPM-BOX <br /> Holding Temperature: COWLFrbN COMPLETION <br /> Method: ora na s rtar. <br /> Screening Method: ofO1^ <br /> Verified Chain of Custody: ❑Yes ONO �n' <br /> —I, n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: alottad <br /> sac5on ..Ti = $ li <br /> Covered: ❑ Yes ❑No » _ gravalPack <br /> If yes, material: (� <br /> GROUTING or DESTRUCTION Total Depth: ()I \ <br /> Grout Material ��Qt.�Qsl yl� 1 t Obi 44 �� 3S'�In = n <br /> Gallons of Grout Used: —38op,t foreyo4*LqP Wptl MATERIALS/DEVELOPMENT <br /> ��� $ Casing Type: <br /> ❑Well Installation Well Dest6ruct--iv Blank Feet Screen Feet <br /> Slot Size: <br /> []Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTremie i (Other: S, Type of Method: <br /> Water ent 471b Water Cement 941b <br /> M <br /> ns Ba s allons BaThinnest s Thickest Thinnest 9Bags Bentonite/Cement MIXW/n MIX -MiX5 1 5 10 1 Bentonite er47lb 1.41 2.4710 2 10 20 2 Bentonite er 94 Ib 2.82 4.715 3 15 30 3 <br /> 20 4 20 40 4 <br /> 25 5 25 50 5 <br /> 30 6 30 60 6 <br /> 353040 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 />