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SAN�10A0UIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring well )oil Boring Inspection Report <br />Date: I0Z/2( Inspector: SLI <br />Facility Address. 9 o Y 14�40rw <br />Well Addres$: <br />WP# ALqL- Well#. <br />Soil Boring#: <br />Drilling Company: YI C — Cip14 e� <br />Driller Onsite: I Affa , 5 <br />Consultant: <br />Geologist: _ <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 />❑ Yes ❑No <br />Verified Chain of Custody: ❑Yes <br />SPOILS <br />Contamination Noted: ❑Yes <br />If yes, spoils storage Location:, <br />Covered: ❑Yes <br />If yes, material: <br />GROUTING or DESTRUCT[ON Total Depth:�� <br />Depth to Water: Y eOIL ;OLin <br />Grout Material. � �AC <br />Gallons of Grout Used. M <br />V <br />ell Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />Li Pressure <br />Grout ❑Over Drill <br />�N, <br />Gravity <br />❑Tremie <br />Water <br />❑Other: <br />❑ No <br />CONSTRUCTION <br />Total Depth: U <br />Drilling Rig Type. <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: To: <br />From: To. <br />From: To. <br />From: To. <br />COMPLETION ❑ Sfiove Pipe ❑Christie Box <br />• rr i►s► � <br />►moi\ �ti <br />Palo <br />•• <br />#i. <br />❑ No h` <br />stctt�d . <br />soon <br />❑ <br />No <br />allons <br />Cement 47ib <br />Bas <br />3% Mix <br />WaterCernent <br />allons <br />941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <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 />35 <br />70 <br />7 <br />17.5 <br />35 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />R'l <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 />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 46$-3420 � F 209 464-0138 � www.sjcehd.com <br />BentvnitelGement Mix__ <br />3% Mix <br />§°I° Mix <br />BeilIonli;8 per �� Ib <br />"1.4'1 <br />2.4� <br />Bentonite per 94 lb <br />2.82 <br />4.7' <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 46$-3420 � F 209 464-0138 � www.sjcehd.com <br />