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SAN JOAQUIN <br />--COU NTY-- <br />Greatness grows her,. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: L�K/ tL Inspector: ?a,51— <br />Facility Address: 2607 Nf Tacdb Wo& !� <br />Well Address: <br />WP# &OQ 216,E Well#: <br />Soil Boring#: % 21 115 <br />Drilling Company: <br />Driller Onsite: <br />Consultant: ✓.S <br />Geologist: �Su" h Q,)b <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />MAILVAu11110re <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: <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: ZO/S, to <br />Depth to Water: FLI <br />Grout Material: ce W <br />Gallons of Grout Used: <br />❑Well Installation --❑Well Destruction <br />El Boring Installation Ekring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Ba <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />uBags <br />2.s <br />5 10 <br />1 <br />5 10 <br />2 <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 15 <br />5 <br />25 s0 <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 />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />j41 I _qW7F <br />ABOVE -GROUND CFwsm-aox <br />COMPLETION COMPLETION <br />Ground Surface <br />grout <br />tt. <br />ft. <br />ft. <br />= o <br />slotted <br />ax5on <br />gn w P--* <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 />