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X11 <br />SHAWN <br />Environmental Health Department <br />—COUNTY <br />c9ircoaN� Greatness grows here. <br />p <br />Monitoring <br />n–Well/Soil Boring Inspection Report <br />Date: < ( b�specto : v " V' �1 , t CONSTRUCTION <br />Facility ddress: Z L' 4e / <br />Well Address: I Total Depth: 47A <br />WP#�O 3 ��Ui> Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: Min 2" Annular EHD Seal Verified: ❑❑ <br />Yes No �Z <br />Driller Onsite: Screen Length From: To: g <br />Consultant: ; h't ; vL _ Filter Pack From: To: <br />Geologist: Sym Bentonite From: To: <br />Grout From: To: <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 />Verified Chain of Custody <br />conn c <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: Or b <br />Grout Material: <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 />COMPLETION ❑ Stove Pipe <br />❑Christie B <br />casing <br />height <br />ABOVE -GROUND <br />COMPLETION <br />Ground Surface 7 - <br />proof <br />=_ <br />� x — <br />ft.` <br />crte�s-nr-eox <br />COMPLETION <br />Bentonite/Cement <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />Z <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 />25 50 <br />5 <br />IS ' <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />slottQd <br />sac5on <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 />Water Cement 471b water Cement 941b <br />allons Bas allons Bags <br />Thickest Thinnest ltBags Thickest Thinnest ttBags <br />ft. <br />Screen Feet <br />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 />1� <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 <br />v✓ww.sjcehd.com <br />