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SAN JOAQUIN <br />—COUNTY - <br />09 Greotness grows here <br />- <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Z- 2I SCI Inspector:AJ,e,i��""' <br />Facility Address: "Zs 5• Ad,&14, SiJ vy_ <br />Well Address: <br />WP# Cv3jaw Well#: <br />Soil Boring#: L 6�e <br />Drilling Company: <?MSA, <br />Driller Onsite: Oahe <br />Consultant:y. <br />Geologist: Te)&' <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />❑ Yes TNo <br />❑ Yes CRNo <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />❑ Yes El No <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: Aftl G&t/ <br />Grout Material: Aet' v C�r•�ew <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation XrBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill /I�� <br />El Gravity ❑Tremie ❑Other:/A- <br />Water <br />allons <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <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 />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 From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />—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 S% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />a 0*11 A ,y Alb -S 10/16/2017 <br />1-6-o <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sucehd.com <br />