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c SAN JOAQUIN Environmental Health Department <br /> " COUNTY <br /> Greatness grows here. <br /> q Monitoring/f Well/Soil Boring Inspection Report <br /> �z <br /> Date: o d I Inspector: bpc-r"K /7 ' CONSTRUCTION <br /> Facility Address: fl0 16_ "7L <br /> Well Address: Total Depth: <br /> W P# 00(1©23 Well#: Drilling Rig Type: <br /> Soil Boring#: (— 2,4-c Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: ; G'K <br /> Driller Onsite: Screen Length From: To: <br /> (� <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes L1 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COAFLfiT10N CC APLEnoN <br /> Method: Ground Suiacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No n� <br /> If yes, spoils storage Location: `10 I abed _ <br /> n B <br /> a�c90r <br /> Covered: ❑ Yes ❑No �_ I <br /> gra packIf yes, material: q 574 <br /> GROUTING or DESTRUCTION Total Depth: so F� /] G -S Y; :$. <br /> - <br /> Depth to Water: 7 n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^- 5 © w <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation*oring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity �rJremie ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest RBags Thickest Thinnest sBags 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 /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> Lt0 0 I a, 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />