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r SANuJOAQU�tr Environmental Health Department 1 <br /> r "�',_2 J —COUNTY— <br /> Greatness grows here. <br /> �1� 7 Monitoring Well/Soil Boring Inspection Report <br /> Date: ZS /G�I Inspector: CONSTRUCTION <br /> Facility Address: I iLQ— t d)� I 7 <br /> Well Address: TotaVO) l Depth: q <br /> / /� (7T <br /> WP# ?j R�13 Well#: ` I Drilling Rig Type: ` f 1 \ <br /> Soil Boring#: i P Min 2"Annular EHD Seal Verified: ❑Yes El No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: Ott j� <br /> Bentonite From: To: <br /> Geologist: <br /> Grout From: To; <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No caging <br /> If yes,location and distance: � height <br /> SAMPLING ABOVE-GROUND thwsrwaox <br /> Holding Temperature: 006PLHTION COMPiETioN <br /> Cirsxitd Surlxf --�--- <br /> Method: groutScreening Method: <br /> 4 ft. <br /> Verified Chain of Custody: ❑ Yes ❑No n, <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: akttgd <br /> a°c7on <br /> Covered: El Yes ❑No c gravat pax <br /> If yes,material: p <br /> GROUTING or DESTRUCTION Total Depth:_ I 1105 <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 47 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation)14oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout []Over Drill Filter Pack Type/Size: <br /> ❑ Gravity remie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 1416 <br /> allons Bags allons Ba s _ <br /> Thickest hlnnest At Thlckest Thinnest #Bags BentOnitelCemeol MIX 3%MIX 5%MIX <br /> 2.s 5 1 s to i Bentonite per 47 lb 1.41 2.47 <br /> 5 l0 2 10 20 2 _ Bentonite Per 941b 2.82 4.7 <br /> ..5 is 3 1s 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> is 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 1 40 BO B <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 />