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amu'" SAN J 0 A 0 U I N <br />Environmental Health Department <br />--COUNTY <br />Greatness grows here. <br />` Monitoring Well/Soil Boring Inspection Reporl <br />Date: Inspector: CONSTRUCTION <br />Facility Address: 27� P <br />Well Address: A- -1 Total Depth: <br />WP# oo 5A -,kA -2 Well#: Drilling Rig Type: <br />Soil Boring#: (-0:- 3 - <br />7�►t�u`� Min 2" Annular EHD S Verified: <br />Drilling Company: TwN <br />Driller Onsite: X �J4_ i Screen Length F m: <br />Consultant: i(j'Z Filter Pack From: <br />Geologist: :5vo. Bentonite From: <br />Grout From: <br />Public Water System Onsite: ❑ Yes *0 <br />Domestic Well Onsite: ❑ Yes YNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of CV(dy: ;E�Yes ONO' <br />Contamin Ion Not : es ❑No <br />If ye , spoils orage cation: <br />red: i <br />/' / ❑ Yes ❑ No <br />If ves. material` <br />GROUTING or DESTRUCTION Total Depth: _ <br />Depth to Water: '-%. <br />Grout Material: N i%w <br />Gallons of Grout Used: t'J-4, <br />[]Well Installation ❑Well Destruction <br />❑Boring Installation *oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />�kravity remie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 94lb <br />Bags <br />Thickest <br />ttBags <br />Thickest Thinnest <br />✓1 Bags <br />2.5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />r20 <br />10 <br />20 <br />2 <br />7.5 <br />3 <br />15 <br />30 <br />3 <br />10 <br />4 <br />20 <br />40 <br />412.5 <br />5 <br />25 <br />so <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 />COMPLETION ❑ Stove Pipe <br />es El No <br />To: <br />To: <br />To: <br />❑Christie Box <br />i <br />:. <br />Co -T10 SL-fa*i <br />ft. <br />M <br />Casing Type: <br />Bla/kettSloBagBagTyporFilt <br />Type of Method:` <br />grout <br />ft. <br />_ - e <br />B <br />diva pack <br />ft. <br />Feet <br />Benton Ite/C empdt Mix 3% ix 5% Mix <br />Bentonite er;# Ib 1.411 2.47 <br />Bentonite Pof 94 Ib V 2.821 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.s*cehd.com <br />