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SAN JOAQUIN <br />Environmental Health Department <br />;'—COU NTY- ---- <br />c4«FonP. Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: % o Inspector: /ui�SC--FrM <br />Facility Address: 3 •S <br />Well Address: <br />WP# Well#: <br />Soil Boring#: _j S 2. <br />Drilling Company:,`U,iJAe 6-4,44 (,-en <br />Driller Onsite: � ,e <br />Consultant: l ll, P"I i�iY Com. <br />Geologist: jai -4'.1 <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: ❑ Yes El No <br />wnii r, <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: <br />Depth to Water: 36 t <br />Grout Material: Ater. -1 �c'r►+Qk� <br />Gallons of Grout Used: <br />❑Well Installation []Well Destruction <br />❑Boring Installation IXBoring Destruction <br />nnFTNnn I icFn <br />❑Pressure Grout MOver Drill <br />❑ Gravity ❑Tre ie ❑Other: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes E] No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 />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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />ate <br />allons <br />nt 411b <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thicket <br />hinnest <br />RBags <br />Thickest Thinnest <br />J1 Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />15 <br />15 30 <br />3 <br />%0) <br />20 <br />20 40 <br />4 <br />11.5 <br />25 <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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes E] No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 />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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />