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SAN JOAQUIN <br />" ---COUNTY-- <br />FC"a�`' Greatness grows her <br />Environmental Health Department <br />'j Monitoring Well/Soil Boring Inspection Report <br />Date: (( It I Inspector: (� <br />Facility Address: '7-Z,5GCK�[il�tC� <br />Well Address: <br />WP# Well#: <br />Soil Boring#: <br />Drilling Company: C A <br />Driller Onsite: <br />Consultant: <br />Geologist:!-} <br />Public Water System Onsite: ❑ Yes 11No <br />Domestic Well Onsite: ❑ Yes <No <br />If yes, location and distance: <br />CAMPI INl; <br />Holding Temperature: <br />Method: <br />Screening Method: <br />I <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑ No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material:��.0 , <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation C Boring Destruction <br />UFTNnn i mrn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Tremie ❑Other: <br />Water <br />allons <br />From: <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />?r Bags <br />Thickest Thinnest <br />bBags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: pt <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe <br />ft. <br />slottad <br />soon <br />tt. <br />MATERIALS/DEVELOPMENT <br />Casing Type: / <br />Blank Feet <br />Slot Size: <br />Bags of Ce ent: <br />Bags Sand Gravel: <br />Type/Br d of Bentonite: <br />Filter P. ck Type/Size: <br />Type o`f Method: <br />Christie Box <br />� 0 a� <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />Av,;uvev 1-130, <br />p '� & /4x- <br />( w 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 />casing <br />height <br />ABovE-GaouNo <br />COWPLErION <br />Ground surl <br />ft. <br />slottad <br />soon <br />tt. <br />MATERIALS/DEVELOPMENT <br />Casing Type: / <br />Blank Feet <br />Slot Size: <br />Bags of Ce ent: <br />Bags Sand Gravel: <br />Type/Br d of Bentonite: <br />Filter P. ck Type/Size: <br />Type o`f Method: <br />Christie Box <br />� 0 a� <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />Av,;uvev 1-130, <br />p '� & /4x- <br />( w 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 />