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SAN JOAQUIN <br />--COUNTY-- <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: t1 1'l t Inspector: (r wor � <br />Facility Address: G-4rOL? (.,MA0e,2li 5 <br />Well Address: " <br />WP# ) 0 "k Well#: j <br />Soil Boring#:� <br />Drilling Company: T&6' V- <br />Driller Onsite: (Li l,�f– <br />Consultant: 6 Bia �L�riU rv- LOMSLL Geologist: <br />CONSTRUCTION (ict rr`1 <br />Public Water System Onsite: ❑ Yes �41\lo <br />Domestic Well Onsite: ❑ Yes 1�No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />CP()11 C <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 1j <br />Depth to Water: v\uw t� <br />GroutMaterial: 0¢rvi` uw.!.w <br />Gallons of Grout Used: l' "NAUDL, S <br />❑Well Installation ❑Well Destruction '2 5, �kr6v" <br />❑Burin Installation �"r� , <br />g mooring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />;�I`Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />NBags <br />Thickest Thinnest <br />ttBags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />10 <br />20 <br />2 <br />7.5 15 <br />If <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 />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 />—ft. <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 />ft. <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.secehd.com <br />