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SAN JOAQUIN <br />—COUNTY <br />Greotness grows herz <br />cr �: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: %O�z fl Inspector: /�'4S4e - -- <br />Facility Address: Z2-02- A0 A- Ro <br />Well Address: <br />WP# ex) 39YZ3 Well#: <br />Soil Boring#: 814 Z, 3, Y <br />Drilling Company: % <br />Driller Onsite: ,QO6�rt <br />Consultant: <br />Geologist: ,aud/a <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />CAMPI Ir\Ir, <br />Holding Temperature: <br />Method: <br />Screening Method: <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: /VO <br />Grout Material: An!iz <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation NLBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie [kOther: 1 1,ee,411 <br />at r <br />allons <br />C ent 4Y1 <br />Ba <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />;Bags <br />Thickest Thinnest <br />ttBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 1 60 <br />6 <br />17.5 35 <br />7 <br />35 1 70 <br />7 <br />20 40 <br />8 <br />40 1 80 <br />8 <br />CONSTRUCTION C� �1eJ, <br />Total Depth: <br />Drilling Rig Type: — 7 <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 ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND C iRt5TY-BOX <br />COMPLETION COMPLETION <br />Ground surface T <br />grout •, <br />ft. <br />slotted = c �— <br />e*Cson <br />r — gr.'�w P. -k Lv <br />xz� — <br />7 <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 3% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />N 2 S,9Ki�. 1 `tci�� 10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com <br />