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SAN.JOAQUIN <br />x_:r� <br />COUNTY <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ���/ Inspector: A01rA ` <br />Facility Address: N• i''iii�el�.✓�r <br />Well Address: <br />WP# c.0t //I Well#: <br />Soil Boring#: ,85- .86 878f f Ag <br />Drilling Company: TP/fiC�GG�� <br />Driller Onsite: •/� <br />Consultant: "aPrsa." <br />Geologist: 'e54r .k <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 />❑ Yes ❑ No <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: /O <br />Depth to Water: AP &gAl <br />Grout Material: ��(4,4 t/ L� <br />Gallons of Grout Used: <br />❑Well Installation []Well Destruction <br />❑Boring Installation tBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ,tOther:/I�;ee� <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Filter Pack <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />zBags <br />Thickest Thinnest <br />uBags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: 6 <br />%lie <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 ❑Christie Box <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank 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 />n. <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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />