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�_;�W� ;: <br />;^";.�" <br />-,:�<� <br />SAN 1UA(�UIN <br />- COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: _ _� 23( �Z Ins ector: N/4 5��" <br />Facility Address: � Z ,� . �/�� dK- �� <br />Well Address: <br />W P#��'�S(,�,y Well#: <br />Soil Boring#: 1S'� l�� � �3Z- <br />Drilling Company: � <br />Driller Onsite: <br />Consultant <br />Geologist: <br />.� <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 />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes <br />❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: q/� L�l�� <br />Grout Material: ,�.� ���J <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation L�Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />S°�o Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />2.82 <br />Thickest <br />Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <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 />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />� ii � <br />�� � \ �� � <br />:. -. <br />� \.- <br />�- :. <br />«. <br />�. <br />.. <br />`V <br />ft. <br />�% Mix <br />S°�o Mix <br />Bentonite per 47 Ib <br />'1.41 <br />2.�4� <br />Bentonite <br />per �4 Ib <br />2.82 <br />4.� <br />— <br />:: <br />`3 <br />s.: <br />yy���� <br />i�li�iL <br />`/r <br />�� <br />�✓ <br />aaCon <br />_ <br />.'3 <br />.. <br />.�,. <br />t- <br />_ <br />-� <br />�µ <br />- <br />. <br />it. <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 <br />it. <br />Feet <br />BentonitelOement Mix <br />�% Mix <br />S°�o Mix <br />Bentonite per 47 Ib <br />'1.41 <br />2.�4� <br />Bentonite <br />per �4 Ib <br />2.82 <br />4.� <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 I F 209 464-0138 � <br />www._slcehd_.com <br />