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_� SAN:IOAQUIO Environmedkl Health Department <br />': ' �' —COUNTY <br />'C9cir`I Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <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 ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 7.7ig ' <br />Grout Material: AJEAT Cx,MLO T <br />Gallons of Grout Used: 7-1)13 <br />*ell Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity 33remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Sags <br />*1 E <br />Date: <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Inspector: tsne& <br />Facility Add <br />es <br />(o 4 34 M1 IWAUECLy in. <br />Well Address: <br />.' &fQ <br />WP# 1)A <br />Well#:-El <br />Soil Boring#: <br />5 <br />Drilling Company: <br />89666 1)'1ZL!_ZA'i' <br />Driller Onsite: <br />20 <br />Consultant: <br />APTIM <br />Geologist: <br />A4",v Parte <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 ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 7.7ig ' <br />Grout Material: AJEAT Cx,MLO T <br />Gallons of Grout Used: 7-1)13 <br />*ell Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity 33remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Sags <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />NBags <br />Thickest Thinnest <br />9Bags <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 />5o <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 />6 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: jyYes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION Stove Pipe ❑Christie Box <br />MATERIALS/DEVELOPMENT <br />Casing Type: PVL &H-EntiLE q6 <br />Blank 'c, Feet Screen Feet <br />Slot Size: <br />Bags of Cement: 11 R <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement Mix 3% Mix 3% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonfte per 94 lb 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.sacehd.com <br />