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SAN JOAQUIN <br />---COUNTY— <br />r caC�,•; v <br />Greatness grows herr. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 1 I s ect <br />r. N <br />Facility Address: 'ZZ <br />Water <br />gallons <br />Well Address: <br />Cement 941b <br />Bags <br />WP# <br />Well#:� <br />Soil Boring#- <br />9Bags <br />Drilling Company: <br />5 <br />Driller Onsite: LUQ <br />5 <br />Consultant: <br />1 <br />Geologist: "he <br />I N" <br />Public Water System Onsite: <br />❑ Yes 4NO <br />20 <br />2 <br />Domestic Well Onsite: <br />4yes ❑No <br />If yes, location and distance: <br />15 <br />30 <br />3 <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Not <br />If yes, spo• storage Location: <br />Cover . <br />Xyes, material: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: �,2 <br />Grout Material: <br />Gallons of Grout Used: �-j"&NW4' <br />❑Well Installation ❑ eW II Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />`Gravity lt�remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />IBags <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 <br />25 <br />5 <br />25 <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 />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />c -IS Cao TSS <br />Min 2" Annular EHD Seal Verified: ❑ ❑No <br />Screen Length From: o: <br />Filter Pack Fro To: <br />Bentonite ro : 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 nto ite: <br />Filter Pac pe/Size: <br />Type ethod: <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 />1� <br />2 �jpmN ,' q VD. 10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />