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°? SARJOAQUIN Environmental Health Department <br />' 1�T� a —COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: I clans ector: <br />Facility Address: U C) R,/A A r.k 1 <br />Well Address: <br />WP# d S Well#: <br />Soil Boring#: <br />Drilling Company: V e1' <br />Driller Onsite: 'r', A g <br />Consultant: j,Af I.2re J al- t-ws <br />Geologist: :: -Q- <br />Public Water System Onsite: ❑ Yes El 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: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth:!:�2c <br />Depth to Water: lt- <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well DestrYtion <br />❑Boring InstallationX&ring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 3X-Tremie ❑Other: <br />Water <br />gall s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />A Bags <br />Thickest Thinnest <br />b Bags <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 />20 40 <br />8 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: y (� I <br />Drilling Rig Type: 9 �\s <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From <br />From <br />From <br />From <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: 1 kj <br />To: <br />❑Christie Box <br />tL <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 />ft. <br />Screen Feet <br />BentonitelCement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />AN <br />"to 50 �allo�s ko 15 CJs <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 <br />10/16/2017 <br />www.skcehd.com <br />