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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: �0 2I Zfj Inspector:�i7 CONSTRUCTION <br />Facility Address: `A-koq jl� RAXI,- <br />Well Address: Total Depth: _ <br />WP# 0bg2UG!) Well#: Drilling Rig Type: <br />Soil Boring#: -'(� - \ <br />Drilling Company: %"N k clklljt FXQyjr iU4'1, Min 2 Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Driller Onsite: <br />Screen Length <br />From: <br />To: <br />Consultant: ; p <br />Filter Pack <br />From: <br />To: <br />Geologist: r <br />Bentonite <br />From: <br />To: <br />5 10 <br />Grout <br />From: <br />To: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />rva,-..01■111M <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes ❑No <br />conii c <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />0 1 <br />GROUTING or DESTRUCTION Total Depth: 3� <br />Depth to Water: 12-1 \'22 <br />Grout Material: wi (kWY1, . <br />Gallons of Grout Used: lz�pc <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation )4oring Destruction <br />'IT1.6r■r l■1 N E14.1 1 <br />El Pressure Grout ❑Over Drill <br />❑ Gravity D6Tremie ❑Other: <br />casing <br />height <br />—QW7F <br />ABCVE-GROUND Crw srr-Box <br />COWFLETION CCMPLETICN <br />Ground Surfacs <br />grcut <br />7 V - <br />ft. <br />ft. <br />1 rpt <br />3Z I <br />tac:cn � <br />Water <br />allons <br />Ce nt 471b <br />Bags <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />0Bags <br />Thickest Thinnest <br />xBags <br />2.5 5 <br />5 10 <br />1 <br />5 10 <br />2 V <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />