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SAN-,IOAQUIN Environmental Health Department <br /> —COUNTY— <br /> �c_._rr <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: f: '�3 Inspector: 0& CONSTRUCTION <br /> Facility Address:_ o"V-` A ,� <br /> Well Address: Total Depth: <br /> WP#car 4,,qf� _t Well#: V-Cifp-� Drilling Rig Type: <br /> Soil Boring#: L� <br /> Drilling Company: .s /� Ice— Min 2"Annular EHD Seal Verified: El Yes []NoDriller Onsite: h� c'� Screen Length From: To: <br /> Consultant: _((`� w�-ti'! <br /> Filter Pack From: To: <br /> Geologist: y�'�' Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLEMN comPL ncN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft• <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> � C <br /> If yes, spoils storage Location: stotd <br /> Covered: ❑ Yes ❑No <br /> If yes, material: _tx = <br /> GROUTING or DESTRUCTION TotalDepth: -S' <br /> Depth to Watery <br /> Grout Material: At I-e"--f <br /> Gallons of Grout Used: r , K t! %��x�s MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Xwell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity XTremie ❑Other: Type of Method: <br /> c <br /> Water Cement 47lb Water Cement 941b <br /> gall Bags gallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest $1Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 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 />