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nuin' <br />SANr�JOAQUIN <br />Environmental Health Department <br />COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 91h3be Ins ector: AnIj <br />Facility Address: /(/ %tee 66 !,�k <br />Well Address: Jq <br />WP# Gb3glf? Well#: <br />Soil Boring#: B/ 62 63 (jy <br />Drilling Company: PA'a w <br />Driller Onsite: d6t,, <br />Consultant: iQvdvhV..- <br />Geologist: Cj"r'3 <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />r nKICTDI Ir'TIrim <br />Total Depth: <br />Water <br />gall ons <br />Drilling Rig Type: <br />Thickest Thinnest ttBags <br />Thickest Thinnest <br />Jt Bags <br />2.5 5 1 <br />Min 2" Annular EHD <br />Seal Verified: <br />❑ 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 />❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: 0 <br />Depth to Water: I <br />Grout Material: NOGG Cw� <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ['Boring Destruction <br />METHOD USED <br />Pressure Grout []Over Drill <br />❑ Gravity ®Tremie ❑Other: <br />Water Cement 47 lb <br />allons Bas <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest ttBags <br />Thickest Thinnest <br />Jt Bags <br />2.5 5 1 <br />5 <br />10 <br />1 <br />5 10 2 <br />10 <br />20 <br />2 <br />7.5 15 3 <br />15 <br />30 <br />3 <br />10 20 4 <br />20 <br />40 <br />4 <br />12 5 25 5 <br />25 <br />50 <br />5 <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <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 />15 3 � fj,t�s lob �°9✓ldw <br />17.5 D <br />20 4o a 4o eo s <br />3y '&'q a f ewwwf <br />L4 0.1 f�dy�rrnf� $% 10/16/2017 <br />fo 18 <br />St/kton, Calif 99205 T 209 468-3420 F 209 464-0138 www.smcehd.com <br />1868 E. Hazelton Avenue I oc I I I I <br />