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���.SAN JOAQUIN <br />t 3rte:` --COUNTY— <br />°9c Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: t C 0`v' t <br />Facility Address: 0� 1"t�(c� lr til <br />Well Address: JOS <br />WP# A `j �-14' Well#: <br />Soil Boring#: 13 t 3 <br />Drilling Company:-C,f-1 <br />Driller Onsite: 0 - V <br />Consultant: (A-,& -I�/� <br />Geologist: cp-r I t7 S <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 />cpnn c <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes <br />❑ Yes No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: VQItIt, <br />Gallons of Grout Used: r- AV <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ['Boring Destruction <br />MFTWnn I mrn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity L�Tremie ❑Other: <br />Water <br />allons <br />From: <br />Cement 471b <br />Bas <br />Water <br />gall ons <br />From: <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />iYBags <br />Thickest Thinnest <br />ttBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />14-1 <br />10 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3> <br />15 <br />30 <br />3 <br />20 <br />Ir <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />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: ❑ 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 />—r— casing <br />T� height <br />ABOVE -GROUND CHRM'rY-BOX <br />COMPLETION COMPLETION <br />Ground sur+ac. <br />grout <br />1 ft. <br />tt. <br />tt. <br />,A C <br />j! A <br />— a <br />tbttad = c <br />a�c9on — B <br />_ = proud goat <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 1.411 2.47 <br />Bentonite per 94 Ib 2.821 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.sucehd.com <br />