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SAN JOA UIN <br /> 2 � f Q EnvironmeriLal Health Department <br /> COUNTY <br /> car. <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: � ay Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: ` Total Depth: L Ic. <br /> W P# (-) O Ct Well#: (::fZ:fwLZbEt Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: N o-- V Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: -!a <br /> height <br /> SAMPLING ABOVE-GROUND _ <br /> Holding Temperature: �t"g'�T�N CCO6AP E-noN <br /> Method: Ground Surface + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —it. <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: atonal :' ,, <br /> sacdonY <br /> Covered: ❑ Yes El No _ grave+P-* <br /> If yes, material: II II ++ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: •2V�(p n- "— n <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation 'A ellDestruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑B Slot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout�Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity -*remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%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 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 5o 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> cc)�, '� Z 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 />