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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> , Greatness grows here. <br /> !� <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 I9 20 Inspector: CONSTRUCTION <br /> Facility Address: 0o f Leul-%� I <br /> Well Address: Total Depth: <br /> WP# ()hit 0u2ts Well#: Drilling Rig Type: <br /> Soil Boring#: W — — <br /> Drilling Company: C Min 2"Annular EHD Seal Verified: El Yes ONO <br /> Driller Onsite: 1, ylAa Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Y1 Gj'U Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO �a casing <br /> If yes,location and distance: height <br /> —CWT <br /> SAMPLING AeoVE-GROUND <br /> COMPLETION COX <br /> Holding Temperature: cOMPLEMoMP�noN <br /> Method: Ground s <br /> Screening Method: growl <br /> Verified Chain of Custody: ❑ Yes El No <br /> SPOILS — <br /> Contamination Noted: ❑ Yes ONO =_ e <br /> �$ <br /> If yes,spoils storage Location: wnoa ". <br /> wc9on � = 8 <br /> Covered: ❑ Yes ONO - aavalvwk <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: I <br /> Depth to Water: NO C-�vJ <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation�Boring Destruction Slot Size: <br /> 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 Bother: Type of Method: <br /> Water ent 47IbN Water Cement 941b <br /> allons Ba gailels Bags <br /> Thickest Thinnest ags Thickest Thinnest uBags _ BentonitelCement Mix 3% MIX 5%MIX <br /> 2.5 5 —1 5 10 1 Bentonits per 47lb 1.4' 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94Ib 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 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 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 />