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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: "g/P Inspector- A40SdW. CONSTRUCTION <br /> Facility Address: Sa/N C 1+��lllt� la..G <br /> Well Address: Total Depth: 5S <br /> WP# &;oyy7LM Well#: P —M`J/0 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: /l/4 taw Min 2"Annular EHD Seal Verified: XYes ❑No <br /> Driller Onsite: Screen Length From: `J To: 1401 <br /> Filter Pack From: To: <br /> Consultant: e. (�• C'oti6�J --�.- <br /> Geologist: w!a M <br /> 57�A1t G• � Bentonite From: 35 To: 3S <br /> Grout From: To:� <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ,Kphristie Box <br /> Domestic Well Onsite: ❑ Yes []No easing <br /> If yes,location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> COMPLETION C10- BOX <br /> Holding Temperature: coMPLEPtETioN <br /> Method: OrwndSutan <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �n• <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No ° <br /> If yes,spoils storage Location: ' <br /> section <br /> Covered: ❑ Yes ❑No <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type:�PUL Se-& � V15 <br /> ;(Well Installation ❑Well Destruction Blank�Feet Screen Feet <br /> Slot Size: • oW <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: 9 S <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: 2 tl J <br /> Filter Pack Type/Size: *ZOIZ- <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method:_ A20k <br /> Water Cement 471b Water Cement 941b <br /> allons eallons Ba s <br /> Thtdcest Throne #Bags 7hitkest Thinnest #Bags Bentonite/Cement Mix 3%MIX 5% MiX <br /> 2.s 1 5 10 1 Bentonite per 47 lb I 1A1I 2.47 <br /> s 2 10 20 2 Bentonite per 94 lb 1 2.821 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 31 70 7 <br /> 20 40 6 ,�{4.0 00 8 <br /> ,� 2i 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 />