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SAN JOAQUIN <br />—COUNTY— <br />`' Greatness grows here. <br />Environmental Health Department <br />�a <br />Monitoring Well/Soil Boring Inspection Report <br />�{ <br />Date: 1 2-(b 2Z Inspector: CONSTRUCTION <br />Facility Address: o V Yr. <br />Well Address: Total Depth: <br />WP# 00 (A Well#: Drilling Rig Type: <br />Soil Boring#: 2 fi — 2--z_ Z Min 2" Annular EHD Seal Verified: <br />Drilling Company: k-1 ff-4 C1 <br />❑ Yes []No <br />Driller Onsite: Screen Length From: To: <br />Consultant: e' A ,'V;q,a' Filter Pack From: To: <br />Geologist: 5CN^P, A Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe El Christie Box <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />CAAAPI IAIr <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 />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes El No Lx <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 'ZDI <br />Grout Material: Pe -o-- c � <br />Gallons of Grout Used: 't- `(S,,a� . -+ �S <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation 08oring Destruction <br />METHOD USED %i( J <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity [kLTremie ❑Other: <br />Water <br />allons <br />C rhent 471b <br />Bas <br />Water <br />allons <br />Bags <br />Thickest Thinnest <br />ags <br />Thickest Thinnest <br />2.5 5 <br />1 <br />5 10 <br />5 10 <br />2 <br />10 20 <br />7.5 15 <br />3 <br />15 30 <br />is <br />10 20 <br />4 <br />20 40 <br />12.5 25 <br />5 ✓ <br />25 5015 <br />30 <br />6 <br />30 6017.5 <br />35 <br />7 <br />35 7020 <br />40 <br />8 <br />40 80 <br />casing <br />height <br />XSOVE-GROUND GNRMTY-BOX <br />COMPLETION COMPLETION <br />Ground sulx. <br />Omit <br />n. <br />ft. <br />O <br />sacdon i = <br />pnwl pads <br />—ft <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 />ft. <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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />