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,z SAN_JOAQUIN <br />*, Environmental Health Department <br />.i'.. COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: x/101/( Inspector: lms► � <br />Facility Address: zVj- SSU^ <br />Well Address: <br />WP#&)'b 6Ze-g Well#: <br />Soil Boring#: 453 <br />Drilling Company: %a60- <br />Driller Onsite: 6 <br />Consultant: /�/oin e►/e��/ rr�_ <br />Geologist: 'Asoma <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />CANADI Mir <br />Holding Temperature: <br />Method: <br />Screening Method: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes El No <br />121111.T.VIM-4 <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: <br />Depth to Water: 2/ <br />Grout Material: Cenv <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ABoring Destruction <br />AACTUfIr% 1 ICM <br />IR2ressure Grout ❑Over Drill <br />❑ Gravity [�firemie ❑Other: <br />Water Cement 471b <br />allons Bas <br />Water <br />Rall ons <br />Cement 94 lb <br />Bags <br />Thicke Thinnest t8a s <br />Thickest Thinnest <br />11 Bags <br />2. 5 t4, 5 1 <br />5 10 <br />1 <br />5 10 2 <br />10 20 <br />2 <br />7.5 15 3 <br />15 30 <br />3 <br />10 20 4 <br />20 40 <br />4 <br />12.5 25 5 <br />25 50 <br />5 <br />15 30 6 <br />30 60 <br />6 <br />17.5 35 7 <br />35 70 <br />7 <br />20 40 8 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes El 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 />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 <br />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 />10/16/2017 <br />In Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />