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p'C1UIryti.� <br />2 <br />c SAN4:JOAQUIN <br />`j <br />—COUNTY— <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: l �+ Inspector: V `� CONSTRUCTION <br />Facility Address: .s y (� MUI J'atC,/� <br />Well Address: Total Depth: l <br />WP# U0 42 Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Driller Onsite: <br />e.t_ eo �X ) Screen Length <br />From: <br />To: <br />Consultant: /^, �� <br />Filter Pack <br />From: <br />To: <br />Geologist: <br />Bentonite <br />From: <br />To: <br />1 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: <br />❑ Yes El No COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <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 />CPrlll C <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No { ,CP- I <br />❑ Yes ❑ No <br />❑ Yes El No <br />❑ Yes ❑ No <br />If yes, material: / <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material:�a—(� G <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />)oring Installation El Boring Destruction <br />M HOD USED <br />El Pressure Grout <br />t�❑Over Drill <br />❑ Gravity 'premie ❑other: <br />Water <br />allons <br />Cement 471b <br />Ba <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest <br />nest <br />NB s <br />Thickest Thinnest <br />#Bags <br />2.5 <br />1 <br />5 10 <br />1 <br />5 <br />0 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />Woasing <br />-T height _QWT <br />ABOVE -GROUND CHMSTY43OX <br />.. - <br />r <br />it <br />_ <br />_ o <br />abttad = B <br />&*clan <br />_ = 9—W P&* <br />M <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.s4cehd.com <br />