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SAN JOAQUIN <br />'L . '• -� —COUNTY_.. <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 04 1 Inspector: AA &tE-w <br />Facility Address: Soo w• Kd <br />Well Address: <br />WP# 003 35'z Well#: <br />Soil Boring#: ill <br />Drilling Company: Mill SA C_ <br />Driller Onsite: <br />Consultant: <br />Geologist: fJ.,tV, <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 />wnii c <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 30, <br />Depth to Water: 10` <br />Grout Material: A b 4- f' <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRLSTY-aox <br />COMPLETION CCMPLETICN <br />Ground Surlaos <br />orl«n <br />n. <br />tt. <br />= e <br />C <br />_ a <br />slotted <br />section <br />= grave, pacts <br />Gallons of Grout Used L 'L MATERIALS/DEVELOPMENT <br />❑Well Installation []Well Destruction <br />❑Boring Installation 5013oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity NTremie ❑Other: _ <br />Casing Type: <br />Blank Feet <br />`y A<t'4tk AASIot 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 <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />41 Bags <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 />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 />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 209 468-34201 F 209 464-0138 1 www.s*cehd.com <br />