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SANJOA Ull, <br /> Q j Environmetrtal Health Department <br /> —COUNTY— <br /> �°'+t_iF_on_�°` Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: '7-4 1 Inspector: h*i10A CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# 00314=-2- Well#: 4p tb r1 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Com an a.a a.~4e- Min 2"Annular EHD Seal Verified: El Yes ONO <br /> p Y� <br /> Driller Onsite: r Screen Length From: To: <br /> Consultant: ��y� "' Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: � t,a>.gne T. <br /> SAMPLING ABOVE-GROUND CHRI,-BOX <br /> T <br /> Holding Temperature: COWLETION COMPLETION <br /> Method: GroundSurlao• <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Non' <br /> _n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: meµ{y K! ff �b <br /> on , I = 8 <br /> Covered: El Yes ONO Yr i#V zt =bf 5 <br /> g-W Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 1S <br /> Depth to Water: ND frv� <br /> Grout Material: /1.�t�fi'Zwt <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> CgellInstallation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> 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 Mother: Type of Method: nr <br /> Water Cement 4714 Water Cement94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest aBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per47lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 is 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 3s 70 7 <br /> 20 40 8 40 so 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 />