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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: � IySz NMI <br /> - <br /> _ __ CONSTRUCTION <br /> Facility Ad ress: 'r](�() S.f [A.11 P4. <br /> Well Address: Total Depth: <br /> WP#I(5h 17 Wellit: Drilling Rig Type: <br /> Soil Boring#- Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: <br /> Driller Onsite: r- Screen Length From: To: <br /> Consultant: M 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 ONO casing <br /> If yes,location and distance: � height T. <br /> SAMPLING ABOVEGROUND T <br /> OOWPLETION COMPL TION <br /> Holding Temperature: cottPtETioN <br /> Method: Ormond su lae+ <br /> Screening Method: grad <br /> Verified Chain of Custody: ❑ Yes ❑Non• <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No ° <br /> If yes,spoils storage Location: abnad <br /> Covered: ❑Yes ❑No 1 = <br /> 0a 1vimk <br /> If yes, material: B <br /> GROUTING or DESTRUCTION Total Depth: (�1 <br /> Depth to Water: <br /> Grout Material: , 1 <br /> 4e' (j0w_ 1 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: - �p <br /> Casing Type: <br /> ❑Well Installation AWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> (Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ant 471b Water Cement 941b <br /> allons Ba s allons nags <br /> Thickest Thinnest a Thickest Thinnest 48ags Bentonite/Cement Mix 3%Mix 5%MIX i <br /> 2s s 1 s io 1 Bentonite per 47 lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 is 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 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 />