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rovo <br />�2 <br />SANkJOAQUIN <br />Is <br />--COUNTY— <br />Greatness grows herr. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Q Z7 Inspector: A44C �c t., -t <br />Facility Address: Z5-66 1N4s-, <br />Well Address: \ <br />WP# L9037yyo Well#: <br />Soil Boring#: t-' ?7- # l <br />Drilling Company:7-4-4a r <br />Driller Onsite: <br />Consultant: Qj N e Q r .17vt .- <br />Geologist: Lim <br />Public Water System Onsite: ❑ Yes I$NO <br />Domestic Well Onsite: ❑ Yes XNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain 94custody: ❑ Yes 11 No <br />SPOILS <br />iination Noted: ❑ Yes El No <br />s, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: j5 <br />Grout Material: Alo« ( caw, Qom, <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation XBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />51fGravity *remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />vallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />tlBags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />If <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 204 <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 />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From- To: <br />Grout Fr To: <br />COMPLETIO ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />-@FWT <br />ABOVE -GROUND cNAssrr eox <br />GOWPLETION i <br />ft. <br />ft. <br />Ground size <br />_ e <br />_ a <br />.8 <br />g, S' Pack <br />r' <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of B tonite: _ <br />Filter Pack Ty /Size: <br />Type of Me cid: <br />een 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 209 468-3420 1 F 209 464-0138 1 www.sacehd.com <br />