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Environmental Health Department <br /> L <br /> —COUNTY— <br /> SANS>JOAQUIN <br /> �•e9C1 ..t' . Greatness grows here. <br /> Monitoring <br /> /Well/Soil Boring Inspection Report <br /> / <br /> Date: � 1,VU, Inspector: l [`rl CONSTRUCTION <br /> Facility Address: '�4 �- <br /> Well Addre s: Total Depth: <br /> WP# O() Well#: Drilling Rig Type: <br /> Soil Boring#: b `I `-- <br /> Drilling Company: G� C 4ej Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: C"A A- CSC 1G� f 2s 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 El No casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLE ION �t.EnON <br /> Method: Ground Surlac*" <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> N � C <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: stoned <br /> sac5on '— <br /> y. <br /> Covered: ❑ Yes El No <br /> if yes, material: Lo <br /> GROUTING or DESTRUCTION Total Depth:. <br /> Depth to Water: <br /> Grout Material: �-t L <br /> Gallons of Grout Used:,-3-7 S � —'U MATERIALS/DEVELOPMENT <br /> �— Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> .Gravity rremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 s 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 7 35 70 1 7 <br /> 20 40 8 40 80 1 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />