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ArrI u -.vo <br />S A N X10 A Q U I N <br />Environmental Health Department <br />-----COUNTY— <br />"tc�Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date:q ZD�I I ector: IdY0' <br />Facility Address: 6 5" r <br />Well Address: <br />WP# 2 Well#: <br />Soil Boring#: <br />Drilling Company: _�,iE>r01'� dr l'tiq , <br />Driller Onsite: <br />Consultant: <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 />Screening Method:_ <br />Verified Chain of Custody <br />Spnll S <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />CONSTRUMON <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />TV height <br />ABOVE -GROUND CHRISTY43OX <br />COMPLETION COMPLETION <br />Ground Suda" <br />grout <br />tt. <br />it. <br />.lotted <br />aeCten —_ <br />_ 9-VIWpack <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:�� _- '?�?i Ct (- <br />Depth to Water: n• .K ft. �]a <br />Grout Material: <br />�OJV MATERIALS/DEVELOPMENT J <br />Gallons of Grout Used: y .{ � r Casing Type: '� d i <br />[]Well Installation ;PWell Destruction N�� `a lank Feet Screen Feet L'r <br />Q Slot Size: fl r. <br />❑Boring Installation ❑Boring Destruction \ Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />❑Pressure Grout ill Filter Pack Type/Size: <br />❑ Gravity r � Other: Type of Method: <br />water <br />ailons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnes <br />Bags <br />Thickest Thinnest <br />NBags <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 />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 />80 <br />8 <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 />