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I� <br />t �SANJOAQUIN <br />is=1=:;"COUNTY— <br />c,N- Greotness orccss here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 1 0A 3 /1 Inspector: Vv <br />Premise Address: <br />WP#: <br />Well#: <br />Soil Boring#. <br />Drilling Company:k rd — <br />� <br />Driller Onsite: d t, <br />Consultant: I A4 ke <br />Geologist: <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 ❑No <br />CONSTRUCTION <br />Total Depth:_ <br />Drilling Rig Type: <br />Min 2" Annular 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 <br />❑ Stove Pipe <br />❑Christie Box <br />casisig <br />height <br />ABOVE -GROUND CtiFii5lY SaX <br />COMIPL�i ION CCMPLE'n0N <br />Ground suciaas <br />grout <br />fi. <br />ti. <br />ft. <br />SPOILS <br />Contamination Noted: ❑ Yes El No '— <br />If yes, spoils storage Location: slotted <br />Covered: ❑ Yes ❑No 'w <br />If yes, material:EE <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />= .. <br />GROUTING or DESTRUCTION To al Dept :5�—o <br />irk <br />14. <br />Thickest Thinnest <br />Depth to Water: (� W <br />Ste` C ft _ <br />Grout Material: <br />r'-*�tiv'iMATERIALS/DEVE LOPMENT <br />Gallons of Grout Used: <br />`t <br />5 10 <br />_b( Casing Type: <br />(°Sj�lank <br />❑Well Installation ❑Well Destruction <br />Feet <br />❑Boring Installation *ooring Destruction <br />Slot Size: <br />3 <br />Bags of Cement: <br />METHOD USED <br />Bags Sand/Gravel: <br />10 20 <br />Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill <br />Filter Pack Type/Size: <br />❑ Gravity remie ❑Other: <br />Type of Method: <br />Water <br />alions <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br /># Bags <br />Thickest Thinnest <br />t Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />15 30 <br />s <br />25 <br />30 <br />50 <br />50 <br />5 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix- <br />Bentonite <br />ix_Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />