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SAN JOAQUIN <br /> • ' '� Environmental Health Department <br /> `n is l'+ <br /> ----COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ` ZZ Inspector: CONSTRUCTION <br /> Facility Address: 4s-0LL vii <br /> Well Address: Total Depth: <br /> WP# Lk_f7�7�fg Well#: Drilling Rig Type: L P <<'l <br /> Soil Boring#: �� -Z�_— c71 Min 2" Annular EHD Seal Verified: 07 ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: l Gc d�• Screen Length From: To: <br /> Consultant: � Filter Pack From: To: <br /> Geologist: Z Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes gTNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 1PN0 casing <br /> If yes, location and distance: height <br /> njT— —EFWT <br /> SAMPLING ABOVEGROUND CHR__ <br /> Holding Temperature: COWLETION COMPLEMN <br /> Method: °`°""°S`°i'" <br /> Screening Method: Or«rt <br /> Verified Chain of Custody: ❑ Yes El No -�--n' <br /> ft. <br /> n. <br /> SPOILS u° <br /> Contamination Noted: ❑ Yes TCJNo <br /> If yes,spoils storage Location: atoxic <br /> a�cdon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: L? <br /> Depth to Water: DQn• n' <br /> Grout Material: <br /> Gallons of Grout Used: ^- lu S MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑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 oTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gall ons Bags <br /> Thickest q1hinnest 9Bags Thickest Thinnest .!Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 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 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 209 464-0138 1 www.socehd.com <br />