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SAN J OAQU I N Environmental Health Department <br /> COU NTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: ) C CONSTRUCTION <br /> Facility Address: Zz ( W . Dro4,6 tR_+ <br /> Well Address: Total Depth: <br /> WP# MO Z Well#: Drilling Rig Type: <br /> Soil Boring#: L1 SV --g Min 2" Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: �D aI"c,�' <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Gi �" f� ` Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> _VwT <br /> SAMPLING ABOVE-GROUND __ <br /> Holding Temperature: COWPLETION COMPtEMN <br /> Method: G=r)d Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft- <br /> ft. <br /> ft. <br /> SPOILS = <br /> .J• <br /> Contamination Noted: ❑ Yes ❑No <br /> >.. = D <br /> If yes, spoils storage Location: <br /> stolid y: <br /> socton <br /> Covered: ❑ Yes ❑No yv , � f — VIVW Pack <br /> s-. <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: A& i✓ ,� �---ft• �" — n- <br /> Grout Material: ew !u° <br /> 5Vek` MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: I <br /> J_7,11 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation NBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> IQG ra ' y XTr 3ie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons -Bags gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest riBags BentonitefCement Mix 3% Mix 5% 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 /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 70 7 <br /> 20 0 40 1 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 />