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SAN J OA Q U I N Environmental Health Department <br /> ii•UI court-n� <br /> `�9��p;-: UlkUill r.SS MOW$ IICtC <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Uu��Ur l In ector: 1 f-la 5 CONSTRUCTION ' l <br /> Facility Add ess: 5 t -: <br /> Well Address: Total Depth: <br /> WP# 00 G; - Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: r rot l� Min 2" Annular EHD Seal Verified: El Yes []No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: — �}" * Filter Pack From: To: <br /> Geologist: SBentonite 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: IT height <br /> T F6 -WWT <br /> SAMPLING AsovE-GROUND <br /> Holding Temperature: CONPLMON COMPLET oN <br /> Method: Ground Surface <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> —ft* tt. <br /> tt. <br /> SPOILS = <br /> �v4 � <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: I(/ atottad <br /> ►rc'c n <br /> Covered: ❑ Yes 11 No <br /> If yes, material: _= <br /> i <br /> GROUTING or DESTRUCTIO Total Depth: <br /> Depth to Water: <br /> Grout Material:. '� ' <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation 4oring Destruction Slot Size: <br /> � IS Bags of Cement: <br /> METHOD USED J Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity KTremle ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest Jt Bags Bentonite/Cement Mix 3% Mix 3% 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 e 30 60 6 <br /> 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />