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SAN JOAQUIN <br />"i COUNTY <br />a: Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection <br />Date: I2 P✓ <br />Z�lnspector: ,, A _ CONSTRUCTION <br />Facility Address: 15 �1 2 V1 d S—�✓P�- <br />Well Address: Total Depth: <br />WP# O o 7 O Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: �--r/D- �� � %t 5J <br />Driller Onsite: <br />Consultant: ��GLGw1 SS oC,lO <br />Geologist: k"k%2- <br />Report <br />OGiC�SMin 2" Annular EHD Seal Verified <br />Screen Length From: <br />Public Water System Onsite: ❑Yes ❑No <br />Domestic Well Onsite: ❑Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: [I Yes ❑No <br />SPOILS <br />Contamination Noted: El Yes ❑No <br />If yes, spoils storage Location: <br />Filter Pack From: <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />IVEoGROUND <br />.. <br />FR <br />is <br />❑ Stove Pipe <br />= I <br />� ��•. �- P <br />slotted -- C <br />I sac Ion —' <br />Covered: El Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: > <br />Depth to Water: 00 <br />Grout Material: .P.6� ✓� <br />Gallons of Grout Used: S <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation�Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity LIP remie ❑Other: <br />Water <br />allons <br />Cemen Ib <br />ea <br />5% Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />9Bags <br />4.7 <br />Thickest <br />Thinnest <br />tlBags <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 />30 <br />60 <br />6 <br />15 <br />30 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />1868 E. Hazelton Avenue Stockton, California 95205 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />Blank Feet Scre <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 />Feet <br />Bentonite/Cement Mix <br />3% Mix <br />5% Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />20821 <br />4.7 <br />10/16/2017 <br />T 209 468-3420 � F 209 464-0138 � www.slcehd.com <br />