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SAN JOAQUIN <br /> COUNTY Environmental Health Department <br /> c4P' Greatness grows here. <br /> C� Monitoring/Well/Soil Boring Inspection Report <br /> Date: l / / Inspector: � A <br /> /0` CONSTRUCTION <br /> Facility Address: <br /> Well Address: 35 6K-0-1-nC(ri0. / Total Depth: <br /> WP#()Q 9 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: D r'we 3f Corr�S�OYt �h �j�l Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> —CWT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMIFoomLETION cPiEn.oN <br /> Method: a°`md Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No .eft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> sec5on u = <br /> Covered: ❑ Yes ❑NoZvi E= gr"�t <br /> ack <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: __ <br /> Depth to Water: fL — n' <br /> Grout Material: AleA G"!'t-e- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: S0 4 Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring 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 /> 54 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen Ib Water Cement 941b <br /> gall ons Ba allons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 9Bags 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 /> is 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 � <br /> �S s l !� �/ 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 www.sacehd.com <br />