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<' SANJ0A0UIN <br />" r -COUNTY— <br />Greotness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 4411ISi Inspector: ,56 - <br />Facility Address: Zo'7 3 S- 6',-,.7!1-/ Pkwy. <br />Well Address: <br />WP# cx3 3kU,2. Well#: <br />Soil Boring#: f <br />Drilling Company: ante« ev'. - <br />Driller Onsite: i4d .-*f <br />Consultant: /V e, ,/ /4.0leYsa111 <br />Geologist: Kra � <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />cnn4oi rnir- <br />Holding Temperature: <br />Method: <br />Screening Method: <br />CONSTRUCTION <br />Total Depth: , <br />Drilling Rig Type: % 110►... g�ir+ r4��?►� <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />Verified Chain of Custody: ❑ Yes EJ No <br />conic c <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: /✓c) Gc✓ <br />Grout Material: MpK f eo"V.- f <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation I<Boring Destruction <br />METHOD USED <br />[9Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94lb <br />Bags <br />Thickest Thinnest <br />kBags <br />Thickest Thinnest <br />tlBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />ti� i"' 13 <br />1868 E. Hazelton Avenue <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑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 />ft. <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 />Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />