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SANJOAQUIN Environmental Health Department <br />—COUNTY --- <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 5 -WI$ Inspector: NRS46— <br />Facility Address: 7-35'do S. Icassoh /Lcl <br />Well Address: <br />WP#" St2oo 77z SfS Well#: <br />Soil Boring#: by 66' <br />Drilling Company: 1/4 r� <br />Driller Onsite: AK61e- <br />Consultant: Wut, 1n"H— <br />Geologist: 'TC)4.t <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />CAKADI Mir- <br />Holding <br />NG <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 />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: 1St <br />Depth to Water: LO' <br />Grout Material: 04A,� C -a ¢wk <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation XBoring Destruction <br />METHOD USED <br />Pressure Grout ❑Over Drill <br />❑ Gravity NTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />4 Bags <br />Thickest Thinnest <br />N 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 />10 204 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />1s 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 />rnkiCTol IrTlnnl <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD 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 ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CNAlsry-Box <br />CONFLETION COMPLETION <br />Ground Surlacs <br />grout <br />tt. <br />tt. _ <br />v � O <br />_ o <br />sbttad = � <br />sac�on <br />grswl pack <br />Y <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 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />