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SAN.JOAUIN° c� <br /> Q Environmert,al Health Department <br /> Y%a''� —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7-11-1^ Inspector: ✓ 3 ts"w CONSTRUCTION <br /> Facility Address: 1-36 s,.,d 4 n'al A e <br /> Well Address: Total Depth: <br /> WP# B039A6S Well#:,V -lib S"Itowl Drilling Rig Type: <br /> Soil Boring#: Sa P-Ilo eAoe? Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: �ta <br /> Driller Onsite: )C) p o Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: TEu Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: � height <br /> SAMPLING AMVE-GROUND CHRls Y-SOX <br /> Holding Temperature: Coh3PLETION ComPLETIoN <br /> Method: Gmnd su lae. �"f7 -- <br /> Screening Method: groct <br /> Joi vaat)Y _#. <br /> Verified Chain of Custody: ❑ Yes ❑No # <br /> SPOILS <br /> 5✓PuoS1+NNo•' <br /> Contamination Noted: ❑ Yes ❑No r i� <br /> If yes,spoils storage Location: `/ -t03 V.Wtw -_ <br /> wclon 3 <br /> Covered: ❑Yes ❑NS eP = g-vs4 pact <br /> ✓ //6 of e <br /> If yes,material: dr&mr q"Oii <br /> GROUTING or DESTRUCTION Total Depth: lSl{ <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 15 Casing Type: <br /> e: <br /> SC(Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout []Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie [60ther: Fe Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> allons Bags allons Baits _ <br /> Thickest Thinnest 41Bags Thickest Thinnest 9Bags _ Bentonite/Cement Mix 3%Mix 5%Max <br /> Is 5 1 5 10 1 Bentonite per 1.41 2A <br /> 5 10 2 l0 20 2 Bentonite per 941b 2.82 4.7 <br /> 7.5 15 3 15 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 0 40 60 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 />