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SAN JOAQUIN <br />f' —COUNTY <br />c.P:' Cirao!ness Jror;c <br />Environmental Health Department <br />Mo-`nitoringWell/Soil Boring Inspection Report <br />Date: N / 13 V� Inspector: �� CONSTRUCTION <br />Facility Address: Z 5 ' OV,J tocGCta v. <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: 0'� fie Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑ No <br />Driller Onsite: e C Adv` Screen Length From: To: <br />Consultant: 0. 2(`'� Filter Pack From: To: <br />Geologist: a- Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <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 />C9Jilllcr <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />casing <br />height <br />ABOVE -GROUND cHswrr-sox <br />COMPLETION COMPLETION <br />Ground sumacs <br />grout <br />ft. <br />ft. <br />= o <br />= o <br />slotted <br />att;ion �;; <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: S 9-S _— <br />Depth to Wate�� �, �3 ft - <br />r: — <br />Grout Material: <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />Slot Size: <br />❑�o <br />Boring Installation ring Destruction <br />Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />❑ Gravity �Tremie ❑Other: Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />Rallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br /># Bags <br />Thickest Thinnest <br />k Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />9 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 So <br />5 <br />15 30 <br />6 <br />3o 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 />ft. <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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sucehd.com <br />