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SAN .,j0 A QU IN Environmental Health Department <br />` - COUNTY— <br />°,Li�o`% Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: t / j 4018 Inspector: <br />Facility Address: I Z 0 0 <br />Well Address: 8 J- <br />s b.e r LJL� <br />WP# obi -Well#: <br />Soil Boring#:t3 ?- <br />Drilling <br />Drilling Company: t^! <br />Driller Onsite: <br />Consultant: LEA do <br />Geologist: /U4.lr[; SSE <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 />SPOILS <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />CONSTRUCTION <br />Total Depth: jj �C "� <br />Drilling Rig Type: 'jam -k Y -C"' <br />Min 2" Annular EHD Seal Verified: ❑ Yes 11 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 />❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Tot I Depth:2--Q" <br />Depth to Water:S` <br />Grout Material: .01c <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationV�goring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity PTremie []Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />N Bags <br />Thickest Thinnest <br />tlBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />15 50 <br />5 <br />15 30 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <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 Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />ft. <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 />?,off' °�" <br />14Z0 <br />10/16/2017 <br />1868 E. Hazelton Avenue I <br />Stockton, California 95205 1 <br />T 209 468-3420 1 F 209 <br />464-012_sjc;ehd.com <br />