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�z � ;SANAAQUIN <br />f COLINTY— <br />'��fYf, Greatness grows herrt- <br />Environmental Health Department <br />Monitoring Well/Soil Boring inspection Report <br />Date: Ins pector• 14UlLvVkiriv , <br />Facility Address: -2-301 'Cl. AC - <br />1 -Well Address: <br />W'4 <br />°�Well4. <br />Boring#: <br />Drilling Company: r^ not <br />Driller Onsite: aVV - S <br />Consultant: Kip. in4e,1 ed <br />Geologist: ASQe-, ( (rte-/O,lr✓P T <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑ Yes <br />❑No <br />❑No <br />SAMPLING <br />-Bags <br />Bentonite <br />Holding Temperature: <br />1 <br />From: <br />Method: <br />2 <br />Screening Method: <br />345 <br />Verified Chain of Custody: <br />❑ Yes <br />❑No <br />SPOILS <br />Contamination Noted:91- <br />Yes <br />❑No <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes <br />❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 77 %a,' <br />Grout Material: <br />Gallons of Grout Used: Jr' <br />❑Well Installation 1]Well.Destruction <br />❑Boring InstallationMRoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity I(Tremie <br />❑Other: <br />CONSTRUCTION <br />Total Depth:_ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />ent 471b <br />Bags <br />Filter Pack <br />-Bags <br />Bentonite <br />W153 <br />1 <br />From: <br />2 <br />345 <br />❑Other: <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 />❑ Yes ❑ N o <br />To: <br />To: <br />To: <br />❑Christie Box <br />teasing <br />11SQVZAt�FbD D <br />CO&FL ETON cg-olsry-Box <br />COMPLE16ON <br />Ground staiacs <br />Oroai <br />iL <br />ft. fl' <br />slonad Yi <br />ss�n <br />gravol pack <br />MATE R IALS /D E VE 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 />Water cement 941b <br />allons Bags <br />Thickest Thinnest #Bags Sentonite/Gement Mix 3% Mix5% mjx <br />5 10 1 Bentonite per 47 Ib 1.41 2,47 <br />10 20 2 <br />30 3 Bentonite per 94 lb 2.82 4,.7 <br />15 <br />17.5 1 35 7 11 35 707 <br />20 40 B 40 00 B <br />8 ins 10/16/2017 <br />'888 E. HaaltortAvon Lie j Stockton, Ca6fornia 952051 T 209 46&,34201 F 2x94640138 1 MMjK.sfcehd.cqM <br />