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Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /1 Inspector:`^ <br />Premise Address: 2-,(,p 777 Iv, N2o�ee/ /fd <br />W P#: /29-37 <br />Well#: 94 <br />Soil Boring#: <br />Drilling Company: eV <br />Driller Onsite: <br />Consultant: Q f , t r, -ToC <br />Geologist: <br />Ell <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 />❑ Yes I(No <br />❑ Yes P[N o <br />❑ Yes []No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: 30f <br />Depth to Water: 6 <br />Grout Material: Pey-H4v Aa. cepµ <br />Gallons of Grout Used: <br />Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />;K2ressure Grout ❑Over Drill <br />❑ Gravity ,Xremie ❑Other: <br />Water <br />gallons <br />SAN)DAQUIN <br />" <br />Water <br />Rallons <br />Li!b <br />—COUNTY— <br />C- ' <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /1 Inspector:`^ <br />Premise Address: 2-,(,p 777 Iv, N2o�ee/ /fd <br />W P#: /29-37 <br />Well#: 94 <br />Soil Boring#: <br />Drilling Company: eV <br />Driller Onsite: <br />Consultant: Q f , t r, -ToC <br />Geologist: <br />Ell <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 />❑ Yes I(No <br />❑ Yes P[N o <br />❑ Yes []No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: 30f <br />Depth to Water: 6 <br />Grout Material: Pey-H4v Aa. cepµ <br />Gallons of Grout Used: <br />Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />;K2ressure Grout ❑Over Drill <br />❑ Gravity ,Xremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Ba <br />Water <br />Rallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Bags <br />Thickest Thinnest <br />xBags <br />2.5 <br />5 <br />? <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 />26 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />3o <br />6 <br />30 <br />6D <br />6 <br />17 <br />35 <br />35 <br />70 <br />7 <br />0 <br />an <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: 3 <br />Drilling %lOu1' <br />FSS"{ <br />Rig Type: <br />'31e," <br />Min 2" Annular Seal Verified: <br />A Yes <br />❑No <br />Screen Length <br />From: -2--0 <br />To: <br />Filter Pack <br />r <br />From: 30 <br />To: <br />7-3` <br />Bentonite <br />From: Z3 <br />To: <br />.2-11 <br />Grout <br />From: <br />To:-' )e- <br />.. <br />height <br />•r� �. sM�s".�c"��, <br />. _. <br />CC,&TLEn ON <br />c=nd SWac* . + <br />grout , <br />21 <br />2 3,,0 <br />sacBon <br />�;; -- • . �: syst pads <br />3y ft. <br />MATE RIALS/DEVE LOPM ENT <br />Casing Type: ,WC- <br />Blank ZS Feet Screen S- Feet <br />Slot Size: '0710 <br />Bags of Cement: gf�!' <br />Bags Sand/Gravel: �7-'44,s;s s� J1 'e- 4 <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement Mix 3% Mix 50% Mix <br />Bentonite per 47 Ib 1 1.4112.47 <br />Bentonite per 94 Ib 1 2.821 4.7 <br />v — <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />