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b2 0 00 <br />S A N z,J OA Q U I N Environmental Health Department <br />i—COUNTY— <br />Grentness grov.s h re. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector* Vv CONSTRUCTION L�j" <br />Premise Address: N1XV ' , � C _t 1 j t <br />WP#. �;�qp� Total Depth: [ �% 0 <br />Well#: Drilling Rig Type: 4 !`-O <br />Soil Boring#: <br />D 'll' C �}�� Min 2" Annular Seal Verified: El Yes ❑No (/ J <br />rl Ing ompan <br />Driller Onsite: nGl�1/t <br />Screen Length <br />From: <br />Consultant: <br />Filter Pack <br />From: <br />F. Geologist: 1.10 k <br />Bentonite <br />From: <br />Method: <br />Grout <br />From: <br />Public Water System Onsite: ❑ Yes ❑No I COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑No <br />SAMPLING <br />Cement 941b <br />Bais <br />Holding Temperature: <br />#Bags <br />Thickest Thinnest <br />Method: <br />2.5 <br />5 <br />Screening Method: <br />5 <br />10 <br />Verified Chain of Custody: <br />❑ Yes <br />❑No <br />SPOILS <br />10 <br />20 <br />Contamination Noted: <br />❑ Yes <br />El No <br />If yes, spoils storage Location: <br />15 <br />30 <br />Covered: <br />❑ Yes <br />❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 19 - .- <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation Xwell Destruction <br />❑Boring Installationoring Destruction <br />METHOD USED <br />❑Pressure Grout❑Over Drill <br />❑ Gravity F;�Tremie ❑Other: <br />Water <br />allons <br />Cement 47 lb <br />Bas <br />water <br />eallons <br />Cement 941b <br />Bais <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <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 />11.5 <br />25 <br />5 <br />15 <br />50 <br />5 <br />is <br />30 <br />6 <br />30 <br />60 <br />6 <br />17,5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />8 <br />40 <br />80 <br />To: If t- <br />T�I <br />To:- <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRMIY-box <br />COWLETION COMPLETION <br />ortxund sutxs <br />grout <br />tt. <br />I IL <br />ft. <br />ft. <br />slcnad "' = <br />sac5on <br />J = cnw+ P-* <br />ss —_ <br />g,2 F= 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 />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 />C�18"eltontUAvefjnue(,Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />