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N ` SAN JOAQUIN <br />- COUNTY <br />Greotness ­�-s her; <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 13I?c ZZ Inspector: kn /iye,`Z <br />Facility Address: I Ltiaes.r!(2 <br />Well Address: <br />WP# 0o'AI `� $ Well#: <br />Soil Boring#: <br />Drilling Company:y 4 w <br />Driller Onsite: <br />Consultant: Ge, (o-, <br />Geologist:. <br />Public Water System Onsite: ❑ Yes El No <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 ❑No <br />gpnll , <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: <br />Depth to Water: 'C✓ •C�- <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation [ lBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />9; Gravity )C]Tremie ❑Other: <br />`L-1 \ C�- �r`4 <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttsags <br />Thickest Thinnest <br />xsags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD <br />Seal Verified: <br />❑ 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 Ct�itS7Y 80X <br />COWPLET30N COMPLETION <br />Ground Suiacs <br />grout <br />tt. <br />tt. _ <br />� _ o <br />- = o <br />storied _ B <br />soc;cn <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 />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />U -Irl_ I�r ti Gh <br />[68 E. Hazelton Avenue I Stockton, California 9520 I T 209 468-3420 1 <br />10/16/2017 <br />F 209 464-0138 1 www.s'cehd.com <br />