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SAN JOAQUIN <br />—COUNTY <br />c Greotness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /Z ! Zd/7 Inspector: N SE6^1. <br />Facility Address: '400 <br />— <br />Well Address: <br />WP# Well#: <br />Soil Boring#: — <br />Drilling Company: 4 <br />Driller Onsite: An 't <br />Consultant: <br />Geologist: �ZfY1 <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 />❑ Yes KNo <br />❑ Yes UNo <br />Verified Chain of Custody: ❑ Yes 11 No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />r <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: it/2a-1 eer✓el <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationXBoring Destruction <br />METHOD USED <br />El Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />allons <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />PBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />37ja�1/3 bass <br />1868 E. H el on Avenue I Stockton, California 95205 <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 />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />WTcasing <br />height <br />ABOVE -GROUND CHRZ-Ty-sox <br />COMPLETION COMPLETION <br />Ground 5urfacs <br />grout <br />ft. <br />tt. <br />ft. <br />e <br />C <br />O <br />atoned '— <br />aatdon <br />= gnvw pack <br />1 F <br />ft. = ft. <br />MATERIALS/DEVELOPMENT <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 />Screen 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 />- 13 Jas mp-d ,`n 37 jgj1CV.c 1'`20 uaed .0 <br />9 yv'-t j-Vre- 91e IP 3 a.4 1-) --q <br />10/16/2017 <br />T 209 468-3420 1 F 209464-0138 1 www.s4cehd.com <br />