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SANJOAQUIN <br />2. COUNTY <br />- <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2 Z/zo/4( Inspector: NdStE.- <br />Facility Address: Gf L2 S.v�- <br />Well Address: <br />WP# 00377!V ff Well#: <br />Soil Boring#: ,813 <br />Drilling Company: 6 -ox <br />Driller Onsite: /oy"e <br />Consultant: go" y <br />Geologist: ;TU� <br />Public Water System Onsite: ❑ Yes LkNo <br />Domestic Well Onsite: ❑ Yes WNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: I <br />Depth to Water: Zg f <br />Grout Material: NC4 e$0*".4 <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation XBoring Destruction <br />METHOD USED <br />Pressure Grout ❑Over Drill <br />❑ Gravity O(Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ABags <br />Thickest Thinnest <br />7f Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20E7d <br />20 40 <br />4 <br />12.5 <br />25 <br />25 50 <br />5 <br />15 <br />30 <br />30 60 <br />6 <br />17.5 <br />35 <br />35 70 <br />7 <br />20 <br />40 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes EJ 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 />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />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 />b6 a ;II(JLA 10/16/2017 <br />H -L0 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />