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r� SAN�JOAQUIN <br />Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date:77,12±1 Inspector: Cvkv1I V -1 —C <br />Facility Address: a l I OcAAZ I / aJ64S h—, <br />Well Address: <br />W P#X 355 S Well#: <br />Soil Boring#: TIZ, <br />Drilling Company: N/ A Vj bvi l � i Nqw <br />Driller Onsite: AiA (Le, <br />Consultant:_ f�eG-�— <br />Geologist: (ii !, S O <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes FNo <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 ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:�„A/_ <br />Depth to Water:_/; <br />Grout Material: AZCuf <br />Gallons of Grout Used: 4_50 <br />[]Well Installation ❑Well. Destruction <br />❑Boring Installation %boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />CONSTRUCTION <br />Total Depth: — <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnmpi FTION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes 111 No <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABov;`-daoutaD <br />CO&FLEr101V CW3t,Sil'-i3oX <br />C-QWLEFiC)N <br />GrRind SWfxs <br />grout <br />n . <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 lb 2.82 4.7 <br />go VQS DU ayllov,S w,f�,Y 10/16/2017 <br />1868 E. Hazelton Avenue I St�ton. DU <br />95205 1 T 209 468-3420 1 F 209 4640138 1 www.sdcehd.com <br />Water <br />allons <br />Cement 471b <br />Ba <br />Water <br />gall] ns <br />Cement 941b <br />Bags <br />Thi <br />t Thinnest <br />#Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60. <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 . <br />8 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: — <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnmpi FTION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes 111 No <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABov;`-daoutaD <br />CO&FLEr101V CW3t,Sil'-i3oX <br />C-QWLEFiC)N <br />GrRind SWfxs <br />grout <br />n . <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 lb 2.82 4.7 <br />go VQS DU ayllov,S w,f�,Y 10/16/2017 <br />1868 E. Hazelton Avenue I St�ton. DU <br />95205 1 T 209 468-3420 1 F 209 4640138 1 www.sdcehd.com <br />