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SANJUAQUIN <br />(,, <br />t� COUNTY <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ItI'Altl— Inspector: luma- [ o,* -.r e0c4Alto <br />Facility Address: 14%}1,rtm? 9-rA <br />Well Address: N..WtV%y-n P R &- <br />WP# 003}317- Well#: <br />Soil Boring#: g2, 1351 0 g 10 ?7(0Drilling Company: V- -Z am iq �,ctaa�25 ; i nL <br />Driller Onsite: ('k.ri5 <br />Consultant: <br />Geologist: WoYh 1, <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 />conic c <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <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 />❑ Yes f�(No COMPLETION ❑ Stove Pipe <br />❑ Yes *No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: 5 �� <br />Depth to Water: 1v0v'_4- <br />Grout Material: Neak C.¢,vwew,k <br />Gallons of Grout Used: <br />❑Well Installation []Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Ozremie ❑Other: <br />Water <br />gallons <br />Cement 47lb <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />5 <br />10 <br />1 <br />5 <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 />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <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 />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />—ft. <br />MATERIALS/DEVELOPM ENT <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 3% 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 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />