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111PnmN-g% <br /> z SANJOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: y 2 Inspector: CONSTRUCTION <br /> Facility Address: W, C 4U �{ <br /> Well Address: Total Depth: <br /> �WP# S Well#: Drilling Rig Type: <br /> soil Boring#: W ' wq <br /> Drilling Company nPIF 0 <br /> Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> f <br /> Driller Onsite: A,h Screen Length From: To: <br /> Consultant: l ydinaO'((7160 Filter Pack From: To: <br /> Geologist: <br /> Bentonite From: To: <br /> ��1?1P11 <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 ChffiIM43OX <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Ground S <br /> Screening Method: orylccd <br /> Verified Chain of Custody: ❑Yes ❑Non' <br /> n. <br /> SPOILS — <br /> Contamination Noted: ❑ Yes ❑No T° a <br /> If es spoils storage Location: '' <br /> 0 <br /> Y P g aloswd <br /> Covered: ❑ Yes ❑No .ate cn rl <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt. n. <br /> Grout Material: Q <br /> Gallons of Grout Used: � MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation KWeII Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Clover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity b(Tremie ❑Other: Type of Method: <br /> Water ment 471b Water Cement941b <br /> allons Ba allons Bags <br /> Thickest Thinnest s Thickest Thinnest #8a8s BentonitelCement Mix 3% Mix 5%Mix <br /> 2,5 5 1 5 10 1 Bentonite per 47lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 15 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 />