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SAN JOAQUIN Environmental Health Department <br />—COUNTY - <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �1o&115 Inspector: t446 <br />Facility Address: )bzl <br />❑ Yes <br />Well Address: <br />SAMPLING <br />WP#t2o -65(26,7 <br />Well#: <br />Soil Boring#: B I <br />L32 <br />Drilling Company: <br />t/4 W <br />Driller Onsite: �1,e <br />1 <br />Consultant: tAjct11acc_j<,A <br />2 <br />Geologist: —So t <br />Verified Chain of Custody: <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑No <br />SAMPLING <br />Thickest Thinnest <br />9Bags <br />Holding Temperature: <br />VBags <br />2.5 5 <br />Method: <br />5 10 <br />1 <br />Screening Method: <br />2 <br />10 20 <br />Verified Chain of Custody: <br />❑ Yes <br />1:1 No <br />SPOILS <br />3 <br />10 20 <br />Contamination Noted: <br />❑ Yes <br />El No <br />If yes, spoils storage Location: <br />5 <br />25 50 <br />Covered: <br />❑ Yes <br />❑ No <br />If yes, material: <br />6 <br />17.5 35 <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 0 /Z I <br />Grout Material: AlXa4- <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationAZBoring Destruction <br />AACTUrM 1 ICCn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Rallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />VBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: 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 />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 />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />