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,ppa 1A, <br /> Environmenwl Health Department <br /> SAN JOAQUli� <br /> ,, Ny Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: afiOlq Inspector: u'1,� � CONSTRUCTION <br /> Facility Address: IAJI <br /> Well Address: ��� Iota] Depth: <br /> WP# t-# ' Well#: Drilling Rig Type: �k <br /> Soil Boring#: I <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: p <br /> Driller Onsite: 3 1 Screen Length From: To: <br /> Consultant: -'' +✓ Zo Filter Pack From: To: <br /> Geologist: 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 <br /> ABOVE-GROUND <br /> Holding Temperature: WMPLErION COMPLEn.ON <br /> Method: Ground Surfws <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nod <br /> SPOILS L fC ���+� �• <br /> Contamination Noted: es ❑No <br /> i/OI I <br /> If yes, spoils storage Lc�cYlolh: saw ,.; ` , <br /> Covered: ElYes El No t+c#on l = S <br /> gnvd pack <br /> If yes, material: Li <br /> GROUTING or DESTRUCTION Total Depth:Depth to Water: n• n• <br /> Grout Material: � 1 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: /� �, ,{ e4 <br /> Casing Type: <br /> ❑Well Installation Kell Destruction Blank Feet Screen Feet <br /> �� <br /> ❑Boring Installation ❑Boring Destruction a� Slot Size:gags of Cement: <br /> c� <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout 1-10ver Drill ��✓ Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity Trerrlie ❑Other: Type of Method: <br /> �/' W <br /> Water Cement Gib Water Ta <br /> allons Bags gallons <br /> Thickest Thinnest #Bags Thickest ThinnestBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 <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 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 F 209 464-0138 1 www.socehd.com <br />