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SA6JOAQUIN <br />COUNTY <br />Greatness <br />OUNTYGreatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �J2 lv 2` Inspector: <br />Facility Address: �liU <br />Well Address((: <br />WP# 0 1 Well#: <br />Soil Boring#: <br />Drilling Company: 0('112 L <br />Driller Onsite: Lij it, P. <br />Consultant:�4771rtAGeologist:, ,� J <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 />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes 11 No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:-91� 5 �-- <br />Depth to Water: W, --27 W <br />Grout Material: T\� (),u (')pkv nJIr-- <br />Gallons of Grout Used:'QnA <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation mooring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity &Tremie ❑Other: <br />Water <br />allons <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />4: Bags <br />Thickest Thinnest <br />Jt Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 1✓ <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />31/ <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 />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />1 80 <br />8 <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <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 />—r— casing <br />♦ height <br />ABOVE -GROUND CHMS1Y43Ox <br />COMPLETION COMPLETION <br />Ground Surface T <br />grout <br />n. <br />Ilk <br />n. <br />C <br />O <br />slotted <br />seo�on <br />_ = g-vw Pack <br />�k = <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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />