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SAN.DJOAQUIN <br />Environmental Health Department <br />—COUNTY— <br />Greatness <br />COUNTY— <br />Greatness grows here- <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /7 Inspector: <br />Facility Address: 02 w - hX <br />of <br />Well Address: <br />wP# va 3 ce 733 Well#: <br />Soil Boring#: &, AZ <br />Drilling Company: <br />Driller Onsite: <br />Onsite: e� f <br />Consultant: Tc�/r�►c��•• <br />Geologist: <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑No <br />SAMPLING <br />From: <br />Bentonite <br />Holding Temperature: <br />Grout <br />From: <br />Method: <br />2.5 <br />5 <br />Screening Method: <br />5 10 <br />1 <br />Verified Chain of Custody: <br />❑ Yes <br />[]No <br />SPOILS <br />2 <br />7.5 <br />Contamination Noted: <br />❑ Yes <br />11 No <br />If yes, spoils storage Location: <br />10 <br />20 <br />Covered: <br />❑ Yes <br />❑ No <br />If yes material: <br />25 <br />5 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD 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 />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: A/Ct r r J 84 t�o i <br />Grout Material: l P/+�►titJ� MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />ITTLT height <br />q M— —TrWT <br />ABOVE -GROUND crwssTY-aox <br />COMPLETION COMPLETION <br />Ground strtx* <br />grout <br />ft. <br />ti. <br />tt. <br />— m <br />— o <br />slotted _ 8 <br />soon — <br />_ = grawt pack <br />[]Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie Other: <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 />,i 10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.swcehd.com <br />at <br />gall ns' <br />ent 471 <br />water <br />Rallons <br />Cement 94 lb <br />Bags <br />Thi <br />Thinnest <br />#Bags <br />Thickest Thinnest <br />tJBags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <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 />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 />,i 10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.swcehd.com <br />