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�� ; <br />��� <br />._ = ,� <br />SAN 1UA(�UIN <br />COUNTY <br />Greatness gre�:�•s here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 731Z3i/Zt Inspector: D✓�ls'�k. <br />Facility Address: /O��' �: „t�%Gr/�'C{' �� <br />Well Address: <br />wP# �Y3s'�( well#: <br />Soil Boring#: /�B/—S�, �— �L��S� <br />Drilling Company: C4sCct�� <br />Driller Onsite: <br />Consultant: <br />Geologist: _ <br />G!• <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 ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑Yes ❑ No <br />❑Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: / / <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Coring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />C�Gravity ❑Tremie ❑Other: <br />Water- <br />allons <br />Cement 471b <br />Bas <br />S°!o Mix <br />YVater <br />allons <br />Cement 941b <br />ea s <br />Thickest <br />Thinnest <br />� Bags <br />4.7 <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 From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />casing <br />height <br />._ <br />ABU' VE-GF�OUND CNASSTY-80X <br />GOMiPLETiON COMPLETION <br />C3round s�rr� .�-.- <br />n�«n <br />tt. <br />ft. <br />ft. <br />_ � <br />•i -� a <br />;-: = r <br />_ o <br />sbrs�d •`%= = c <br />iac;cri '� -- � <br />;r: — <br />..� — <br />.�}yX �' <br />.�� <br />.:Y--• �� <br />ft. �` - 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 />Screen <br />Feet <br />BentonitelGement Mix <br />3°�o Mix <br />S°!o Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per �4 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd,com <br />