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SAN_JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring <br /> Well/Soil Boring Inspection Report <br /> Date: f I� ` Inspector: A I I!�'�'y � CONSTRUCTION <br /> Facility Address: I26 Ij (1D (o <br /> Well Address: ifTotal Depth: <br /> WP#W3 a s Well#: Drilling Rig Type: <br /> Soil Boring#: k_rc. t4 we� Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: Kra a o-� 10 SSo <br /> Driller Onsite: ,S �yr,n., Screen Length From: To: <br /> Consultant: a-t7Ao Ass"14'0. p Filter Pack From: To: <br /> Geologist: yj— 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 ❑No casing <br /> If yes, location and distance: W- T <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: cot��iON cCOMPPLEnoN <br /> Method: Ground Surf=* <br /> Screening Method: Oran <br /> Verified Chain of Custody: ❑ Yes El No .L—ft. <br /> ft. <br /> ft. <br /> SPOILS - <br /> Contamination Noted: ❑ Yes ❑No r` <br /> If yes, spoils storage Location: stoned <br /> aKJon <br /> Covered: ❑ Yes El No <br /> a gr.,;W p--.k <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �7 + 0 = 13 4 <br /> Depth to Water: V-10 <br /> Grout Material: llyg-X (O_W-Lem <br /> Gallons of Grout Used: 10 40.. MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑ �B <br /> Boring Installation Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> CA Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement71b water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 5 q0j (5 txjS 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.socehd.com <br />