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SA N J OAQ U I N Environmental Health Department <br /> COUNTY- <br /> r <br /> Greatness grows <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: L.. CONSTRUCTION <br /> Facility Address:—d ; r <br /> Well Address: 24.9 Vel_ Total Depth: <br /> WP# 00 ?rc4iq Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: V a Min 2"Annular EHD Seal Verified: El Yes []No <br /> Driller Onsite: ,(,. rvk. Screen Length From: To: <br /> Consultant: j4.40 t `P.41 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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: con'FLrION L _otti LEnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> C <br /> If yes, spoils storage Location: slotted ' <br /> sac�on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ <br /> Depth to Water:—W tt tt' <br /> Grout Material: ,n.c&k- e_t vs^w.i MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation C2/ell 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 tlefremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags Bentanite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 16 20 2 Bentonite per 94 Ib 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 204 20 40 4 <br /> 12.5 25 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 209464-0138 1 www.socehd.com <br />