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_``°r=� SAN JUA[�UIN <br />"' �-;� �'�_ COUNTY-- <br />. ::�..4- <br />c„ -"� ��'� Greatness rows hers-. <br />Date: / 23 Zt <br />Facility Address: �3 <br />Well Address: <br />W P# d0 `�3.� y B' <br />Soil Boring#: i y <br />Drilling Company: � <br />Driller Onsite: <br />Consultant: pe <br />Geologist: /a <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: /✓�`S�w- <br />3�-s��. <br />Well#: <br />..� .'� <br />r <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 />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <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 From: To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />i ii � <br />i� � � \�L��a�\ <br />/ �/� Vii. <br />:. • . <br />�- :. <br />.. - <br />�. <br />/ % •• <br />//. <br />`u � <br />ft. <br />SPOILS -,= <br />ra ` �� <br />�.-= � ._ <br />Contamination Noted: ❑Yes ❑ No '`� = <br />}.. <br />If yes, spoils storage Location: stoned ��� _ <br />:,: — <br />aa�ro� <br />Covered: ❑Yes ❑ No =_ <br />�::' ..._ <br />If yes, material: ''� _ <br /><;?k <br />�,. <br />� :: <br />GROUTING or DESTRUCTION Total Depth: i'i .� _ �. <br />Depth to Water: N s��`' n' <br />Grout Material: n/�i- �i2s�+�f <br />Gallons of Grout Used: �"���//CKs <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation L�Boring Destruction <br />METHOD USED <br />❑ P'ressure Grout ❑Over Drill <br />L� Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />ea s <br />5°�o Mix <br />Water <br />allons <br />Cement 941b <br />ea s <br />Thickest <br />Thinnest <br />kBags <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 />ZO <br />4 <br />20 <br />40 <br />4 <br />25 <br />50 <br />5 <br />12.5 <br />25 <br />5 <br />30 <br />60 <br />6 <br />15 <br />30 <br />6 <br />35 <br />70 <br />7 <br />17.5 <br />35 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <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 />�� <br />Screen <br />ft. <br />Feet <br />BentonitefOement Mix <br />3°o Mix <br />5°�o Mix <br />Bentonite per �� Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 I T 209 468-3420 � F 209 464-0138 I ' <br />www.s�ceh.com <br />