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SAN$JOAQUIN <br /> a <br /> L-11%6 Environmental Health Department <br /> {; —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report Ali <br /> Date: s'` 1 Inspector: �k) _ CONSTRUCTION <br /> Facility Address: V <br /> Well Address: Total Depth:110tf I <br /> WP# Well#: Drilling Rig Type: P.A <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <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 /> 17 <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: 0016PLETION COOMMEMN <br /> Method: Ground Surface + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No -�--n' <br /> n. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> C <br /> If yes,spoils storage Location: slonod <br /> sac.on <br /> Covered: ❑ Yes ❑No <br /> gravel P-* <br /> If yes, material: <br /> p <br /> GROUTING or DESTRUCTION Toa De the <br /> Depth to Water: tt• n' <br /> Grout Material: <br /> Gallons of Grout Used: ( � MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation EfWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags of Cement: <br /> METHOD USED 1✓�� 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 Cement 471b Water Cement 941b <br /> allons Bas vallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 11 Bags Bentonite/Cement Mix 3% Mix S%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 1 25 5 25 50 5 <br /> 155 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> / ab, <br /> J--e— 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 />