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► r <br />SAN�IOAQUIN <br />'2 z. Environmental Health Department <br />COUNTY <br />Greatness <br />Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 1 1 L )-1 Inspector: ifo-w- C t <br />Facility Address:_ 50V V,0 w j Or - <br />Well Address: _ <br />WP#Well#: <br />Soil Boring#: <br />Drilling Company: ahe <br />Driller Onsite: {Z 1 , I-ruvwf',' 60, E F3'rw'41K> <br />Consultant: -" w <br />Geologist: y0.rIXN <br />Public Water System Onsite: ❑ Yes JIGo <br />Domestic Well Onsite: ❑ Yes XJNo <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 />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes El No <br />rnNCTRI IrTInN <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 />casing <br />height <br />.ABOVE -GROUND C41RISTY-BOX <br />COMPLETION COMPLETION <br />Ground sung. -+ <br />grout <br />n. <br />ft. _ <br />O <br />— o <br />stottod <br />sac�on "— <br />vn<++n+ pack <br />If yes, material: 04 o <br />GROUTING or DESTRUCTION Total Depth:_ Zvi ' <br />D % ft. — ft. <br />epth to Water*— ', <br />Grout Material:y-)ca� U/VVI-4 (7lJ _ioMATERIALS/ DEVELOPMENT <br />Gallons of Grout Used: L 0 <br />V <br />' Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />Slot Size: <br />El Boring Installation oring Destruction Bags of Cement: <br />METHOD USED ll Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill <br />Filter Pack Type/Size: <br />4 -Gravity ❑Tremie ❑Other: Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />AlBags <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 />15 <br />30 <br />3 <br />10 <br />20 <br />20 <br />40 <br />4 <br />12.5 <br />25 <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 />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.slcehd.com <br />