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SAN J OAQ U I N Environmental Health Department <br /> -- -COUNTY----- <br /> Greatness grows here. <br /> Monitoring4Well/Soil Boring Inspection Report <br /> Date: /1 1 Inspectorl0�!a /7 ' CONSTRUCTION <br /> Facility Address:_A0V?0"4'- G'r_ <br /> Well Address: �- Total Depth: <br /> WP# g3 Well#: Drilling Rig Type: b I✓1 • � � ' <br /> Soil Boring#: a / 8 Z10-3- 0 eLt Min 2"Annular EHD Seal Verified: ❑ Yes 11 No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ✓G! CO h 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 /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO�"F�ION CCOMPP EnON <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> ft. <br /> SPOILS <br /> liiz _ -8 <br /> Contamination Noted: ❑ Yes El No r` <br /> If yes, spoils storage Location: slontod ,_ 3 <br /> aKJan <br /> Covered: ❑ Yes ❑No g-%vi pack <br /> If yes, material: U <br /> GROUTING or DESTRUCTION Total Depth: d F4 C�9) _ <br /> Depth to Water: OY� n- n' <br /> Grout Material: e-fL1" MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 6 d Q cd Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction 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 /> T�FGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest aBags 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 1 40 80 8 <br /> 5-q Jt� I q bi 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 />