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'°I , SAN JOAQUIN <br />Q Environmental Health Department <br />1-J3iV' —COUNTY-- — <br />°9c�' Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 711-3)19 Inspector: /yyls��� <br />Facility Address: XI 70d iv, -"/�/� <br />Well Address: <br />W P# '16 :' 1-X i4 y Well#: <br />Soil Boring#:.a °/ A5 <br />Drilling Company: <br />Driller Onsite: <br />Consultant: w'�* <br />Geologist: 1,1fttyL <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />❑ Yes ❑ No <br />❑ Yes []No <br />Verified Chain of Custody: ❑ Yes El No <br />CPr)ll C <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: 2 <br />Depth to Water: it -Z) C-;- v <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie [--]other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />qa1lons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />11- Bags <br />Thickest Thinnest <br />ABags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD <br />Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />+� height <br />ABOVE -GROUND CHRSSTY43OX <br />CONFLETION COMPLETION <br />Ground Surface <br />grout <br />n. <br />tt. <br />4: = - <br />- o <br />.toned <br />sacdon — <br />_ = prawl pack <br />Y - <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1 1.41 2.47 <br />Bentonite per 94 Ib 1 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com <br />