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/QpOUl/y C.., <br /> SANoJOAQUIN <br /> COUNTY <br /> Environmetlill.al Health Department <br /> t, l <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> 4 /Date: Z inspector: a1� %JACONSTRUCTION <br /> Facility Address: ?�}fj L;-P h >Z , 90'L � �]^ <br /> Well Address: Q Total Depth: <br /> WP# t 0 Well#: i g y Drilling Rig Type: <br /> Soil Boring#: <� <br /> Soil <br /> Company: �"" / Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling fir^ C Screen Length From: To: <br /> Driller Onsite: N� .� s � Filter Pack From: To: <br /> Consultant: <br /> Geologist: A a , r � I+ Bentonite From: To: <br /> w7 Grout From: To: <br /> Public Water System Onsite: <br /> El ❑Nom . COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COIPLEMN CADMP�LEnnooN <br /> Method: Grund Sumacs <br /> Screening Method: grout —�l <br /> t� <br /> Verified Chain of Custody: El Yes El No rat 61 <br /> ft. <br /> SPOILS = <br /> - <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abnad ,_ <br /> 9 <br /> Covered: <br /> El ❑No d (3-/ <br /> = ,morel P_* Z;t <br /> If yes, material: <br /> e jpt <br /> GROUTING or DESTRUCTION Total De theIF ii� Af� <br /> Depth to Water: J - — n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El Boring Destruction 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 ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> Ilons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest &Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.s 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 35 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 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 />