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1. <br />SAN.,IOAQUIN <br />" I_ 1%- —COUNTY— <br />r9Asdr Greatness oro,;, <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report f03c) <br />Date: /4 in ctor: V" v •� CONSTRUCTION I �o o <br />Premise Address: �(`� Mi • <br />WP#: 003 3 Total Depth. <br />Well#: 94 Drilling Rig Type: <br />S ring#: Min 2" Annular Seal Verified:'Yes ❑No <br />Drilling Company: A P.�(' <br />Driller Onsite: AA clr Screen Length From: To: 3c7 <br />Consultant: lQ to Filter Pack From: To: 30 <br />Geologist: t-0 % L- Bentonite From: To: <br />Grout From: To: Svc✓"cQ <br />Public Water System Onsite: ❑ Yes L la COMPLETION ❑ Stove Pipe Christie Box L+ <br />1 <br />Domestic Well Onsite: ❑ Yes 9lo <br />If yes, location and distance: <br />SAMPLING O—P�'�l� t yol <br />Holding Temperatur ,rcco 'f"PcG n,C <br />Method. <br />Screening Method: <br />Verified Chain of Custody <br />M061116l <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes El No <br />❑ Yes El No <br />❑ Yes ❑No <br />If yes, material: 2 ^, <br />GROUTING or DESTRUCTION Tot I Depth: JV <br />Depth to Water: l ' <br />Grout Material: <br />Gallons of Grout Used: c <br />,-,,Well Installation ❑Well Destruction <br />i ❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure GroutXTremie <br />❑Over Drill <br />❑ Gravity ❑Other: <br />water <br />gallons <br />Cement 471b <br />Bas - <br />water <br />Rall ons <br />Cement 941b <br />Bais <br />Thickest Thinnest <br />4? Bags <br />Thickest Thinnest <br />4Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />35 <br />60 <br />70 <br />6 <br />7 <br />17.5 35 7 <br />20 40 <br />40 <br />80 <br />8 <br />casing <br />height <br />ABOVE-GRCUNO CtiRM Y -BOX <br />CONFLEi'ION COMPLETION <br />Ground Suriar a <br />grout <br />ft. <br />� <br />z g, tt• _ 23 <br />3106da S <br />sa�c:on <br />3o n. <br />MATERIALS/DEVELOPMENT <br />Casing Type: le V i_ <br />Blank Z,97 Feet Screen -5—Feet <br />Slot Size: d Z Q <br />Bags of Cement: <br />Bags Sand/Gravel: 5—n1.)—' <br />xO <br />Type/Brand of Bentonite: S. e `1�fe <br />Filter Pack Type/Size: E SGLM.C, <br />Type of Method: �jr1Qm�aa�Q <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 />j n <br />k� L <br />186TE. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjc m <br />