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SAN 10AQUIN <br />—COUNTY— <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />2.1 <br />Date. Inspector. <br />Facility Address: <br />Well Address: 2 - <br />W P# <br />Soil Boring#: <br />Drilling Company: �10t._ <br />Driller Onsite: <br />Consultant: ,c n A <br />Geologist: <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 />Verified Chain of Custody <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />CONSTRUCTION <br />(4/ Total Depth:[ C 4;;, Well#: l �rilling Rig Type: J <br />Min 2" Annular EHD Seal Verified: ❑ Yes []No <br />Screen Length From: To: <br />d S6� Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: /V 19 w c�Pd <br />Grout Material --e- <br />Gallons of Grout Used: 115 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation bring Destruction <br />nnrTunn I1CCn �// <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity emie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Sags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />BBags <br />Thickest Thinnest <br />tfBags <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 />35 <br />[�'40 <br />70 <br />7 <br />20 <br />0 <br />8 <br />80 <br />8 <br />BOW, � <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 />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-342( <br />138 1 <br />0/16/2017 <br />