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SAN JOAQUIN <br />COUNTY - <br />`oy Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 121. ZZ Inspector: <br />Facility Address: <br />Well Address: <br />WP# PO Well#: <br />Soil Boring#: J IL4I.Z 1k <br />Drilling Company: _ ULD <br />Driller Onsite: <br />Consultant: v.p 1 Y\ P" der— <br />Geologist: M r 15 <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 />CONSTRUCTION <br />I?W ��' <br />Total Depth: <br />Drilling Rig Type: <br />❑ Yes []No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND GHF1Z Y43OX <br />CONFLFTION comPLEncN <br />Ground surfxt <br />grout <br />ft. <br />tt. <br />ft. <br />= e <br />_ o <br />slotted <br />socdon <br />qn W Pack <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 2U/ �b <br />Depth to Water: n n' <br />Grout Material: <br />Gallons of Grout Used: ti MATERIALS/DEVELOPMENT <br />Casing Type: <br />[]Well Installation []Well Destruction Blank Feet <br />❑Boring Installation Woring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />X -Gravity ❑Tremie El Other: <br />Water <br />allons <br />ent 471b <br />Bas <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />A s <br />Thickest Thinnest <br />tlBags <br />1.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 1 <br />15 30 <br />3 <br />10 10 <br />4 1 <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 />8 <br />40 80 <br />8 <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/Gement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 941b 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.secehd.com <br />