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SAN, JOAOUIN <br />rWfjlc. '`' —COUNTY— <br />� 7C_Y <br />`c9c Foa�`P' Greatness grows her <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:'317-heInspector: <br />Facility Address: x'-14tj5f% /Vk& 1 e <br />Well Address: <br />WP# t1D a ,p4 Well#: <br />Soil Boring#: A) <br />Drilling Company: h C <br />Driller Onsite: <br />Consultant: <br />Geologist: F,S <br />Public Water System Onsite: ❑ Yes 11 No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes []No <br />SPOILS <br />Contamination Noted: ❑ Yes [I No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION ITotal Depth: <br />Depth to Water: tom► <br />Grout Material rpwyw <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />,Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Wat r <br />allo <br />C ent 4 b <br />Bas <br />Water <br />allons <br />Cement 94lb <br />Bags <br />Thickest Thinnest <br />gs <br />Thickest Thinnest <br />ttBags <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 />40 <br />40 80 <br />8 <br />0 �0 <br />1868 E. Hazelton Avenue <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 />casing <br />height <br />ABOVE -GROUND CNAsm-aox <br />CONFLErION COMPLETION <br />Ground Surlacs <br />grout <br />tt. <br />ft. <br />R. <br />_ o <br />slotted = c <br />section — <br />= grew+ pack <br />fix: <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 />10/16/2017 <br />Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />