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SANJOAQUIN <br /> (w Environmental Health Department <br /> 1�' r�•!I'z COUNTY <br /> Greolness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: —f�a 3 Inspect gr: � �JP CONSTRUCTION <br /> Facility.'ddress: / we,, 1� <br /> Well Address: Total Depth: <br /> WP#00 *qD � / <br /> Well#:� �y2O�Drilling Rig Type: <br /> Soil Boring#: ZZ <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Driller Onsite: <44c)7b Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: &e? /il�e Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GFIDUND <br /> COlrti'LEION COMPL MON <br /> OX <br /> Holding Temperature: cornal.ErioN <br /> Method: Gmnd SuiacI <br /> Screening Method: arout <br /> Verified Chain of Custody: ❑ Yes ❑No —n <br /> _n. <br /> n. <br /> SPOILS <br /> Ye = e <br /> Contamination Noted: El Yes ONO _ <br /> If yes,spoils storage Location: ' <br /> Covered: ❑ Yes ONO — aaval Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:__6 <br /> Depth to Water: !�G <br /> Grout Material: Cp l� 3 740 <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation XWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑BoringDestruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> []Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons BaRs <br /> Thickest Thinnest aBags Thickest Thinnest aBags BentonitelCement Mix <br /> 3%MIX 5%MIX <br /> Is s 1 s 10 1 Bentonite er 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.821 4.7 <br /> 7.5 15 3 1s 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 s0 5 <br /> is 30 6 30 60 6 <br /> 17.5 35 7 1 35 70 7 <br /> 20 40 1 40 30 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 />