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SKJOAQUIN <br /> ilk °'% _COU <br /> Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: AlAr-iH, CONSTRUCTION <br /> Facility Address: 5-3od wr7004✓a,6I la <br /> Well Address: Total Depth: <br /> WP#ao yZ V 15f Well#:SVS� QS-,3 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Coo e.we Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: !,Wlfk Screen Length From: To: <br /> Consultant: �Ta co Aj Filter Pack From: To: <br /> Geologist: i2/.k Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: height <br /> —CWT <br /> SAMPLING ABOVE-GROUND <br /> CONPLETION COMPLETION <br /> Holding Temperature: con4rlErloN <br /> Method: Ground suiar4 '+"-- <br /> Screening Method: orout <br /> Verified Chain of Custody: El Yes ONO <br /> ft. <br /> tt. <br /> SPOILS <br /> a <br /> Contamination Noted: ❑ Yes ❑No ;r <br /> If yes, spoils storage Location: <br /> .wtro fi <br /> e 1 = � <br /> s4cdon <br /> Covered: ❑ Yes ❑No = gntvalack <br /> If yes, material: <br /> ' r = <br /> GROUTING or DESTRUCTION Total Depth:Z5 32 <br /> Depth to Water: ZO <br /> CGrout Material: fD&/&4 ' Ar 2e LW16-4 MATERIALS/DEVELOPMENT <br /> )Gallons of Grout Used: Ntavf to %,+ <br /> Casing Type: <br /> ❑Well Installation C7Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> L9Pressure Grout []Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags _ <br /> Thtdcest Thinnest !!Bags Thickest Thinnest #Bags _ Bentonitelcement Mix 3°/a Mix 5°/a Mix <br /> 2.5 5 1 5 10 1 IlBentonite per 47 lb 1 1.41 ', 47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 1 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 B 40 BB 0 <br /> A4"3e ".r 10/16/2017 <br /> raid ��`/�rA.y+! <br /> 1868 E. Hazelton Xenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />