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,/Pnur.w <br />,, �Q —�.. �_.t�, <br />:�. ; <br />I <br />'-cgciFoa��P <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �{-7�-Z-� Inspector: i'►f��� CONSTRUCTION <br />Facility Address: / � � �� [�t•�cL�� CF►•� � <br />Well Address: Total Depth: <br />WP#��-fin � � Well#: -N-7 � �-� �S'Drilling Rig Type: <br />Soil Barin #• �•�� 7,� <br />g I EHD S I V •f• d• <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑Yes ❑No <br />SPOILS <br />Contamination Noted: ❑Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION <br />Depth to Water: N��i,,� <br />Mln 2 Annu ar ea erl le . <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout <br />COMPLETION <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />i iii � <br />�����j�` <br />\ �� <br />:. - . <br />�- :. <br />.. - <br />� � .. <br />�u <br />ft. <br />rs: �� <br />v� __ <br />:>. �� <br />>� — <br />_i stottQd Y '— . <br />5 �o� <br />,:� <br />Total Depth: ��-`� _. . <br />�: <br />. � Q �" �h ��v ti��s <br />ft. '� — <br />Grout Material: /VC�� Cc�w�� .. <br />Gallons of Grout Used: Z�^ u�� �3'��`��L���`"�' <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />�°�° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />4.7 <br />Thickest <br />Thinnest <br />tieags <br />2.5 <br />S <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 />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 _ <br />Slot Size: <br />Feet <br />Bags of Cement: _ <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />A <br />m <br />0 <br />c <br />Screen <br />ft. <br />Feet <br />BentonitelOement Mix <br />3°�° Mix <br />�°�° Mix <br />Bentonite per 47 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 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />