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SAN JOAQUIN Environmental Health Department <br />COUNTY- <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ©6 'Iolu <br />Inspector: <br />Facility Address: 12-i'to <br />S- ylowun Val <br />Well Address: <br />Thickest Thinnest <br />WP# ()C)U2Q� �A <br />Well#: <br />Soil Boring#: r,f2� <br />, : ��► fib'?, <br />Drilling Company:. XDtuo <br />p� <br />'1k0 G'1P��5QXlf Uf�,� <br />Driller Onsite: <br />1 <br />Consultant: <br />2 <br />Geologist: �Vv <br />20 <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 />❑ Yes ❑ No <br />❑ Yes El No <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />GROUTING DESTRUCTION Depth: <br />Depth to Water: <br />ARTotal <br />Grout Material:'• <br />Gallons of Grout Used: , <br />'e/ f51 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />El Pressure Grout XOver Drill <br />❑ Gravity re ❑Other: <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout <br />COMPLETION <br />From <br />❑ Stove Pipe <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND GHMSTY43OX <br />COMF°LEfION COMPLETION <br />Ground Surface <br />(�� C grout <br />❑ No <br />El No <br />U a*eeion <: _.7 g-vlw Pack <br />MATERIALS/DEVELOPMENT <br />1 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 />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <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 />8 <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.s4cehd.com <br />