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G� 71 r� i <br />SAN- J0A0UIN Environmental Health Department <br />I' `j�w �:,F �l C O U N T Y-- <br />�rgY'' Greatness grows i'tere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: � Inspector:gPJVIiI q/M (VQ. <br />Facility Address: r-1' <br />Well Address: <br />WP# Well#: <br />Soil Boring#: I <br />Drilling Compan %UnrYalcco.- <br />Driller Onsite: Ar le 0 <br />Consultant: TgAf Meg <br />Geologist: o-- S <br />Public Water System Onsite: ❑ Yes ❑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: ❑ 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:�� r <br />Depth to Water: 1)1J V1Q 0 a5 <br />Grout Material: <br />Gallons of Grout Used: I / p <br />v <br />❑Well installation ❑Well- Destruction <br />❑Boring Installation lS(eoring Destruction <br />METHOD USED <br />❑Pressure Grout Dover Drill <br />❑ Gravityf Tri� , Vbther: I� <br />�o -4-- 1"K <br />Water <br />gallons <br />ement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ags <br />Thickest Thinnest <br />OBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60. <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />8o <br />8 <br />CONSTRUCTION <br />Total Depth:_ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />- height <br />A. <br />�VS.& 3txttvo <br />cot t�7lor� CHRM-r-Box <br />COMPtETioN <br />crouna suras <br />2rcut <br />i� <br />. storad Y <br />2 <br />_ gv-v* Pack <br />ft. <br />MATE R IALS / D EV E LO P M ENT <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 />BentonitelCement Mix 3% Miix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 Ib 2.52 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 4640138 1 mvw.sicehd.corn <br />