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SANJOAQUIN <br />" lI—ii Ft. "•—COUNTY— <br />Greatness crows Frere <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:/4///6 /9 Inspector: /V«' <br />Premise Address: <br />W P#: <br />Well#: <br />Soil Boring#: Ari <br />Drilling Company: 4 API^ <br />Driller Onsite: <br />Consultant: 4 o'I'm ) Ch, -ZKC <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 />Verified Chain of Custody <br />CPnll C <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ANo <br />❑ Yes A o <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes []No <br />GROUTING or DESTRUCTION Total Depth: 30' <br />Depth to Water: A 1 <br />Grout Material: �,�r¢/l 4eec.C� <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation [Boring Destruction <br />METHOD USED <br />XPressure Grout ❑Over Drill <br />❑ Gravity ATremie ❑Other: <br />Water <br />fa Ions <br />Cement 471b <br />Bas <br />Water <br />oallons <br />I <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />2Bags <br />Thickest Thinnest <br />Bags <br />2.5 1 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 1 <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 />1 <br />25 <br />25 <br />50 <br />5 <br />1 <br />30 <br />30 <br />s0 <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 />Min 2" Annular 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 />casing <br />height <br />J1EMSE RC NII <br />�.oArfi'L.ETION GsiccwLr-nt.�-rt0Nor� <br />Grwnd Smlgcs <br />grout <br />ii. <br />in <br />--ft. <br />C <br />_ O <br />siattnd `�, _ <br />stcr�on <br />_._.._..._tt. <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 50% Mix <br />Bentonite per 47 Ib 1 1.411 2.47 <br />Bentonite per 94 Ib 1 Z821 4.7 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />