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ri <br />c- <br />ar SANJOAQUIN Environmental Health Department <br />—COUNTY— <br />y`�g Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: VV_ CONSTRUCTION <br />Facility ddresqO, <br />Well Address: (� joi UGt .� Total Depth: , <br />WP# Well#: - Drilling Rig Type: <br />Soil Boring#: • <br />Drillin Com an Min 2" Annular EHD Seal Verified: )(Yes ❑No <br />g p Y� ,�Gri_�' i l l i ✓1 <br />Driller Onsite: _Gev-w,aXX Screen Length From: a 3 To: 3_ <br />Consultant: ,Iixobs Filter Pack From: a 0 To: 55 <br />Geologist: M .do- Bentonite From: ( 2• To: oto <br />Grout From:_2 To: IS/ <br />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />casing <br />If yes, location and distance: eight <br />SAMPLING <br />ct•iF3rsr�i-sox <br />Holding Temperature: co�snirrtor� cFJFILS Y -BCI <br />UiON <br />Method: GrWna sum <br />Screening Method: grow <br />Verified Chain of Custody: ❑ Yes ❑No f- <br />it. <br />SPOILS — <br />= r c <br />Contamination Noted: El Yes ❑No - _— -� o <br />If yes, spoils storage Location: _ <br />stotiad = 3 <br />salon .��.- <br />Covered: ❑ Yes []No <br />— <br />ifyes, material: pack <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water: a Vat <br />Grout Material: f—C.4- c2 + <br />Gallons of Grout Used: 4/0 <br />XWellInstallation❑Well- Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity NeTremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 341b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 s <br />1 <br />5 <br />10 <br />1 <br />s <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60. <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />r <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 <br />ft. = ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: 504 y 0 <br />Blank2?3_Feet Screen /�_ Feet <br />Slot Size: <br />Bags of Cement: q <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <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 />I t <br />10/16/2017 <br />T 209 468-3420 1 F 209 464-0138 1 wnAv.sicehd.com <br />