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SAN-J0AQUIN <br />-COUNTY- <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 3D12 <br />Inspector: (fir4L �I <br />Facility Address: --a'5 <br />5 • /�s Jro� l <br />Well Address: <br />Thickest Thinnest <br />WP# lw <br />Well#: <br />Soil Boring#: L <br />I bw'ac '1 <br />Drilling Company: <br />�'V'Li L,OA-S <br />Driller Onsite: <br />Blank Feet <br />Consultant: S{c�an,.L Fu J�+�� S a�llbrl i�ul�iwLEt� <br />Geologist:�rtc� <br />10 <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes .0 No <br />❑ Yes /HNo <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />(5L- 3` <br />I�s <br />CONSTRUCTION <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 />GROUTING or DESTRUCTION Total Depth: 19 -- <br />o'Depth <br />Cement 471b <br />Bas <br />Water <br />vallons <br />Depth to Water: 1.01 <br />��� `� n• <br />Thickest Thinnest <br />Grout Material: Ot <br />(j`i-%,,'� <br />Gallons of Grout Used: A, (� <br />MATERIALS/DEVELOPMENT <br />77 <br />1 <br />Casing Type: <br />❑Well Installation ❑Well Destruction <br />Blank Feet <br />❑Boring Installation VCoring Destruction <br />Slot Size: <br />10 <br />Bags of Cement: <br />METHOD USED <br />Bags Sand/Gravel: <br />3 <br />Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill <br />_ <br />Filter Pack Type/Size: <br />❑ Gravity ,B'�remie ❑Other: <br />Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />vallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />"Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />= <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 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 1.411 2.47 <br />Bentonite per 94 Ib 2.821 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 />