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f2 <br />SAN JOAQUIN <br />�E= i --COUNTY-- <br />Greatness grows herr <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: S 6� yZ <br />Inspector: ( iv( aawL� <br />Facility Address: 292,tG, <br />&w�o 19W1. y <br />Well Address: <br />Thickest Thinnest <br />WP# Ob l J <br />Well#: <br />Soil Boring#: (' t <br />fS t(-, j I mo' P3 <br />Drilling Company: <br />_ <br />Driller Onsite: <br />1 <br />Consultant: `(`�-C�`^ <br />2 <br />Geologist: <br />A;�La ok <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 />❑ Yes �NNo <br />❑ Yes iN o <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: ZD ` ��'� <br />Depth to Water: 't Vl (' <br />Grout Material: <br />Gallons of Grout Used: 'I. I W r G v`Vi j <br />❑Well Installation ❑Well Destruction <br />El Boring InstallationIN60ring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />4Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />zallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />uBags <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 />12.5 25 <br />5 <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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION ❑ Stove Pipe <br />❑ Yes El No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 S% 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. Haz:Mton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />