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"'"`•Z <br />SKJOA SAN�IOAQUIN <br />Y— Environmental Health Department <br />r. „a <br />`c/FoaF, Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: -3LZj1V Inspector: <br />Facility Address: Z.//l 14Aeu A1j,s� <br />Well Address: <br />WP# 00 3T29z Well#: <br />Soil Boring#:(��, 137 <br />Drilling Company: �.✓Cb�— �a we� <br />Driller Onsite: <br />Consultant: <br />Geologist: )Vde a <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes El No <br />❑ Yes ❑No <br />SAMPLING <br />Water <br />gallons <br />Holding Temperature: <br />Cement 94 lb <br />Bags <br />Method: <br />ttBags <br />Screening Method: <br />AlBags <br />Verified Chain of Custody: <br />❑ Yes El No <br />SPOILS <br />5 <br />Contamination Noted: <br />❑ Yes El No <br />If yes, spoils storage Location: <br />10 <br />Covered: <br />❑ Yes ❑ No <br />If yes, material: <br />2 <br />GROUTING or DESTRUCTION Total <br />Depth: 'Ze <br />Depth to Water: <br />15 <br />Grout Material: J1,�.�csw.-•✓ <br />3 <br />Gallons of Grout Used: <br />20 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation XBoring Destruction <br />RACTUrlin 1ICM <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />allons <br />From: <br />Cement 47 lb <br />Bags <br />Water <br />gallons <br />From: <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />AlBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <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 />B <br />40 <br />80 <br />s <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes []No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />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 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />Z 5�I�GN 6S 10/16/2017 <br />v <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />