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12 <br />SAN._JOAQUIN <br />" t —COUNTY <br />°4ciFoa?;P' Greatness grows here <br />Date: 11 A 1 1 - <br />Facility A dress:_ <br />Well Address: <br />`J��(� <br />WP#(AM <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: _ <br />Consultant: -Q2 <br />Geologist: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: 5zd l r� . CONSTRUCTION <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 />If yes, material: <br />Well#: <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: 1i <br />Depth to Water: N0'd- taekuStA 020W) <br />Grout Material: (\P-6J- <br />Gallons <br />\6J-Gallons of Grout Used: F , 15ovn <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation IRLBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ZTremie ❑Other: _ <br />7 <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />11 Bags <br />Thickest Thinnest <br />b Bags <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 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Screen Length From: <br />To: <br />Filter Pack From: <br />To: <br />Bentonite From: <br />To: <br />Grout From: <br />To: <br />COMPLETION ❑ Stove Pipe []Christie Box <br />casing <br />height <br />ASOVE-GROUND CNASSTY-BOX <br />CO&FLErION CC APLETICN <br />Ground surtx. <br />grout <br />N�,. <br />— m <br />_ o <br />slotted <br />Bacton <br />_ = Qrawl pacfc <br />IFn. <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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />