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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY— <br /> °qac Greatness grows here- <br /> Monitoring <br /> ere. <br /> I Monitoring/Well/Soil Boring Inspection Report <br /> Date: I Inspector: te/'a /01 A CONSTRUCTION <br /> Facility Address: <br /> Well Address: 35- GK-Q•yt of�-ip. � Total Depth: <br /> WP#00 39 L S 3 Well#: 3 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: G <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 0-ar"3:f _j_.0S;0r 'oh �j-0/ 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 ❑No casing <br /> If yes, location and distance: height <br /> Iff— <br /> SAMPLING Agpyg.GRpUNp <br /> Holding Temperature: COMPLETION CC#APPLEn.00N <br /> Method: Ground Sudacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> M <br /> tt. <br /> SPOILS ' _ <br /> Contamination Noted: ❑ Yes E]No = <br /> If yes, spoils storage Location: ston.d <br /> s�clon <br /> Covered: ❑ Yes ❑Nogra_ vel <br /> pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 4. =_ <br /> Depth to Water: tL — tt' <br /> Grout Material: Pill MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: s <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <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 /> 54 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water CemenIb Water Cement 941b <br /> Ilons Ba 111 s Bags <br /> Thickest Thinnest NBags 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 /> s 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 /> is 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />