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�ip1 <br />SWN OAQUIN <br />(� Environmental Health Department <br />t —COUNTY--- <br />�,cP✓/ Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: I?i���u Inspector: `, &-,,e,,'a �,' 2 <br />Facility Address: )/ <br />Well Address: <br />WP# ii'(i 2,P C) Z Well#: <br />Soil Boring#: ZC– 2- – t90 <br />Drilling Company:MM ` <br />Driller Onsite: <br />Consultant: <br />Geologist: `�_,� �,i,94 A-4 <br />rnK]C,TPI irTInN <br />4 <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />I: AIRVA,unarN <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑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: <br />Depth to Water: Vt W - <br />Grout Material: AkU1 (t.w-J <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ErBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Asrremie ❑Other: <br />Water <br />allons <br />Cemen 71 <br />Bas <br />Water <br />izallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />4 Bags <br />Thickest Thinnest <br />11 Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 <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 />B <br />40 80 <br />8 <br />r(1NCTRIIrTInN <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 />rr1MPl FTInN <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 />_CWT <br />ABOVE -GROUND crwsm48ox <br />COMPLETION COMPLETION <br />Ground surface <br />grout <br />ft. <br />ft. <br />ft. _ <br />9F �' • <br />M = <br />_ o <br />BICtted <br />secion _ <br />gni P.* <br />fL IF= 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 />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 />W I&I Lj_1r_f.7> 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 />