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SAN JOAQUIN <br />—COUNTY— <br />F '- Greutneis gror:s herr <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: E�izi <br />Facility Address: 1950 )Pl� -t/>9�c d <br />Well Address: <br />W P # ez-)_ 3 g-7'0 Well#: <br />Soil Boring#: I&)" J3� <br />Drilling Company: <br />Driller Onsite: GO/� <br />Consultant: _%QG <br />Geologist: A16P,11-11"d <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />Holding Temperature: <br />Method: <br />Screening Method: <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 />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />❑ Yes ❑No <br />Covered: ❑ Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: SD I <br />Depth to Water: 1 q' <br />Grout Material: (me -t f <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation XBoring Destruction <br />METHOD USED <br />Pressure Grout ❑Over Drill <br />❑ Gravity 5?Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />xBags <br />Thickest Thinnest <br />uBags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHR*TY-8OX <br />COMPLETION COMPLETION <br />Ground Sumacs If <br />grout <br />ft. <br />lnd <br />tt. <br />_ - o <br />_ o <br />_ = cnw+ sack <br />MATERIALS/DEVELOPM 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 />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 />1,205016" <br />,�7� <br />1868 E. Haz ton Avenue I Stockton, California 95205 1 T 209 468-3420 <br />10/16/2017 <br />F 209 464-0138 1 www.s'cehd.com <br />