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SAN JOAQUIN Environmental Health Department <br />l' <br />—COUNTY -Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: z3 / Inspector:/T411ti CONSTRUCTION <br />Facility Address: <br />Well Address: /27Z E•� <br />WP# Well#: <br />Soil Boring#: <br />Drilling Company: =.+G <br />Driller Onsite: .44i'A'G <br />Consultant: Goer <br />Geologist: Ak,,' az!05,i / <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />wnn c <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes El No <br />If yes, material: <br />0 <br />GROUTING or DESTRUCTION Total Depth: .4O <br />Depth to Water:. <br />Grout Material: Nt& e4mew-e <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation XBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity [;KTremie ❑Other: <br />Water <br />allons <br />From: <br />Cement 47lb <br />Bas <br />Water <br />gallons <br />From: <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />sBags <br />Thickest Thinnest <br />9Bags <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 IM <br />25 <br />25 <br />50 <br />5 <br />15 <br />30 <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 />Total Depth: <br />Drilling Rig Type: <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 />casing <br />height <br />ABOVE -GROUND CIHRISTY-BOX <br />COLVLETION COMPLETION <br />Ground sumac* <br />grout <br />n. <br />ft. <br />ft. _ <br />_ a <br />s►ottaa <br />aKson — 8 <br />_ = gravel Pads <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 />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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />