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1 <br /> SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greafness nror.s here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: P"5 - 2- Inspector: CONSTRUCTION <br /> Facility AddressSC o4Syarc-40,_ Ae_ <br /> Well Address: Total Depth: <br /> Wp# Z 7 Well#: Drilling Rig Type: <br /> Soil Boring#: /.3-14 Pr tObtw <br /> /Jic1� E <br /> Min 2"Annular EHD Seal Verified: ElYes El NO <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Afflinr Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ASCIVE•GROUND <br /> C0WLErl0N CHRLSW43OX <br /> Holding Temperature: COMPLEMN <br /> Method: Oround Burlac. <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r = " <br /> If yes,spoils storage Location: atomd <br /> &4aton ' _ B <br /> Covered: ❑ Yes ❑Nogra Pack <br /> a <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ . <br /> Depth to Water: 7 H. tt. <br /> Grout Material: <br /> Gallons of Grout Used: /r7 5vll�a e MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationkBoring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> []Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity kTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags BentonitelCement MIX 3% MIX 15f. MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 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 so 5 <br /> 1s 30 6 30 60 6 <br /> 17.5 35 1 35 70 7 <br /> 20 40 8 40 00 B <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 />