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U�p � <br />c SAN JOAQUIN Environmental Health Department <br />—COUNTY-- <br />�c4�,� Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: I IU Z Inspector: SCA,; ✓Y&3 CONSTRUCTION <br />Facility Address: 1$13 T�inoi OVa <br />Well Address: h iCPO[ Total Depth: <br />WP# QDy2!6 Well Drilling Rig Type: <br />Soil Boring#: 0 Al Q <br />Drilling Company: i-4��1 �1P Ls[; Min 2" Annular EHD Seal Verified: ❑ Yes []No <br />�► jC.j°1.n"i lig ('iih <br />Driller Onsite: Screen Length From: To: <br />Consultant: �C fi(1CI ikV'e/�j Filter Pack From: To: <br />Geologist:6La j ( 'I(, Bentonite From: To: <br />h Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑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 />SPOILS <br />Contamination Noted: ❑ Yes ❑ No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 25 1 <br />Depth to Water: We mer <br />Grout Material: N �U <br />Gallons of Grout Used: 20 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation XBoring Destruction <br />nnt`TNnn l irrn <br />❑Pressure Grout ❑Over Drill <br />-Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eall ons <br />Cement 94 lb <br />Bas , <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />2.5 <br />5 <br />1 <br />5 <br />l0 <br />1 Z <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 />TS <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 />casing <br />height <br />A OVE-GROUND CHRMTY480X <br />00166'LEMN COMPLETION <br />Ground surfw* <br />gran <br />n. <br />n. <br />n. <br />_ <br />C <br />— o <br />an <br />= Brawl pack <br />n. = n. <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.s*cehd.com <br />