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SAN JOANIN Environmental Health Department <br /> --COUNTY <br /> Grentaess grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: t G <br /> Well Address: Total Depth: <br /> WP#21AD�S1 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: — Filter Pack From: To: <br /> Geologist: IA1;11 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> COWLETION COMPLEn Ox <br /> Holding Temperature: coti+rLETioN <br /> Method: Ground$uiace 'ram <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ONO ft. <br /> tt. <br /> SPOILS <br /> k e <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> dotted — 3 <br /> sec,'on 4 = B <br /> Covered: ❑ Yes ONO <br /> 9-W Pack <br /> If yes, material: c <br /> GROUTING or DESTRUCTION Total Depth: 111I •S) =_ <br /> Depth to Water: tt• — tt. <br /> Grout Material: QefAAF Ct MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation AWell 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 /> lPressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Otement 471b Water Cement 941b <br /> allons B30 Rallons Bags <br /> Thickest Thinne p Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5 o Mix <br /> 2.5 5 11 1 5 10 1 Bentonite per 47 lb IIA11 2.47 <br /> 5 le 2 10 20 2 1 Bentonite per 94lb 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 35 70 7 <br /> 20 40 8 40 00 0 <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 />