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nu`" SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY....... .. <br /> rq� ji Greatness grows here. <br /> /Innspector: <br /> onitoring Well/Soil Boring Inspection Report <br /> Date: L�/' ' J CONSTRUCTION <br /> Facility Address! 0 <br /> Well Address: Total Depth: <br /> WP# ;"')���{ c'O � Well#: f((� Drilling Rig Type: <br /> Soil Boring#: C +� "Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: '- ' <br /> Driller Onsite: Lv Screen Length From: To: <br /> Consultant: -y. <�J � i _ , 'Filter Pack From: To: <br /> �3o)Geologist: �3 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION EnoN <br /> Method: Ground SLrf=t <br /> Screening Method: F9Agrout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> tt. <br /> tt. <br /> SPOILS <br /> Ix <br /> = a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: slotted <br /> a�edon __ 8 <br /> Covered: ❑ Yes ❑No a = g-vol <br /> If yes, material: pack <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n- fL <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation -kWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring_p.est.ucjtion Bags iz Cement: <br /> TkIQD USED Q'4& Bags Sand/Gravel: <br /> S i Type/Brand of Bentonite: <br /> 5 Pressure Groin ver�rill+ <br /> yr Filter Pack Type/Size: <br /> Gravity Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> gall Bags gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest »Bags Bentonite/Cement Mix 3% MIX 30%MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 310 20 4 20 40 4 <br /> 12.5 25 5 25 5o 5 <br /> 15 30 6 1 30 60 6 <br /> 17.5 35 7 35 70 7 ✓/L,.3t ,� `�t)` �— ,`C7 V"� ez_ 1 _ a'" O J <br /> 20 40 8 40 80 8 CO Z <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />