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SAN JOAQUIN <br />1i•- —COUNTY--- <br />Greatness <br />COUNTY— <br />Greatness grows her: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �17 / Inspector: <br />Facility Address: /7£5W �' sc_h�l fe- r <br />Well Address: <br />wP# cx0397 l 4l Wen#: <br />Soil Boring#: 8 137, <br />Drilling Company: M4)1 ` <br />Driller Onsite: <br />Consultant: rC <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 />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 11 No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />conn c <br />Contamination Noted: ❑ Yes El 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: <br />Grout Material: e e4y[4- <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation XBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ;KQther: z �� <br />Water <br />allons <br />Cement 471b <br />Bas <br />at <br />gallons <br />Ce AWrnt 9 4 1 b <br />k Bags <br />Thickest Thinnest <br />9Bags <br />Thic <br />Thinnest <br />rl ags <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 />[- r <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND C411RL5TY-BOX <br />COWLETION cowLEncN <br />Ground surra". <br />✓� u <br />grout <br />ft. <br />ft. <br />w <br />= o <br />slotted = c <br />sec Jon — � <br />_ . = Qrawl pxk <br />R <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 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br />