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3� <br />v <br />SAN.JOAQUIN Environmental Health Department <br />COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: w CONSTRUCTION <br />Facility Address: -2Zx!-D U o I IV <br />Well Address: _(�� d LA) . S <br />WP# Well#: <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: 6 <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature:_ <br />Method: <br />Screening Method: <br />Verified Chain of Custody <br />❑ Yes ❑ No <br />Contamination Noted: ❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Covered: ❑ Yes <br />❑ Nc <br />If yes, material: <br />2.5 5 <br />GROUTING or DESTRUCTION Total Depth: <br />5-C, <br />Depth to Water: <br />5 10 <br />Grout Material: <br />10 20 <br />Gallons of Grout Used: — <br />7.5 15 <br />❑Well Installation ❑Well Destruction <br />15 30 <br />❑Boring Installation *oring Destruction <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �remie ❑Other: <br />Water <br />allons <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bas <br />Thickest Thinnest <br />9 Bags <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 />25 50 <br />5 <br />15 30 <br />6 <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 />Total Depth: C�'� TS �C- <br />Drilling Rig Type• <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRMTY-BOX <br />CONFLErION COMPLETION <br />Ground Strfac <br />groEA <br />ft. <br />ft. <br />ft. <br />slotted <br />ascSon "— <br />_ g w Pack <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 />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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.s*cehd.com <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRMTY-BOX <br />CONFLErION COMPLETION <br />Ground Strfac <br />groEA <br />ft. <br />ft. <br />ft. <br />slotted <br />ascSon "— <br />_ g w Pack <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 />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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.s*cehd.com <br />