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ti. = SAN- JOAQUIN <br />—COUNTY— <br />I-c'strFoat`�' Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: o6 V Z7 In ector: 5 CONSTRUCTION <br />Facility Ad ress: 2� Y`U S <br />Well Address: Total Depth: <br />wp# Q0!A153S0 Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: Min 2" Annular EHD Seal Verified: <br />I\'.130 vc) A 3v <br />❑ Yes ❑No <br />Driller Onsite: <br />Screen Length <br />From: <br />To: <br />Consultant: <br />Filter Pack <br />From: <br />To: <br />Geologist: C►(A(/J <br />Bentonite <br />From: <br />To: <br />5 10 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: <br />❑ Yes El No COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: -1 7 5b 5 <br />Depth to Water: I p W +C• <br />Grout Material: k C <br />Gallons of Grout Used: D <br />❑Well Installation ❑Well Destruction -% D aS <br />❑Boring InstallationAoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity KTremie <br />❑Other: <br />Water <br />allows <br />Cement 471b <br />Bas <br />Water <br />RAIows <br />Xement 941b <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thrones <br />ags <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 />3 <br />15 30 <br />3 <br />10 20 <br />4 <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 />casing <br />height <br />ABOVE -GROUND cHRwy-Sox <br />COMPLETION COMPLETION <br />Ground surface <br />grout <br />ft. <br />ft. <br />ft. <br />o <br />O <br />slotted v _ B <br />eec9on =,_ — <br />_ = gravel Pack <br />ttIF_ tt. <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 />►�Z 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.slcehd.com <br />