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SANdOAQUIN <br /> Environmental Health Department <br /> �` _•.; :.• � —COUNTY— <br /> Greatness grows here. <br /> �f Monitoring Well/Soil Boring Inspection Report <br /> Date: � l� Inspector: CONSTRUCTION <br /> Facility A dress: 2JGW &y <br /> WeII Address: Total Depth: <br /> WP# WeII#: d( Drilling Rig Type: <br /> Soil Boring#: TX ��6 X 2b` <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: tUAK . Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No —r casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> cl <br /> Holding Temperature: CowLE ION compuzrioN <br /> Method: Ground su lacy T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —h <br /> SPOILS <br /> e <br /> P <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: <br /> totted <br /> sallon <br /> Covered: ❑ Yes ❑No g-vw— Pack <br /> If yes, material: n� _ <br /> GROUTING or DESTRUCTION Total Depth: IA �/I x 6 Ak <br /> Depth to Water: ft. — ft. <br /> Grout Material: n <br /> Gallons of Grout Used: n. -V MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> g �[ioring Destruction gags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> "Gravity remi ❑Other: Type of Method: <br /> Water ement 471b Water Cement941b <br /> allons Bags allons Ba <br /> Thickest mmnes mickest Thinnest #Bees BentonitelGement Mix 3%Mix 5%MIX <br /> 2.5 5 1 5 10 1 Benionite er 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentoniie per 94lb 2 A21 4.7 <br /> 7.5 15 3 1s 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 3D 80 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 4D 80 6 <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 />