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- raUlt�� <br />�_�°�-�;�2� SAN JOAQUIN <br />l" �, ;:�;; -<J COUNTY <br />`:°�LiP�'t Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: -7� ZL Inspector: I+��S ��+�^ <br />Facility Address: %� gl �• �r�t � f t ��� /?� <br />Well Address: <br />WP# ��13e� 3"-b Well#: ���' <br />Soil Boring#: <br />Drilling Company: ��� ��� <br />Driller Onsite: <br />Consultant: <br />Geologist: �4,��r-��-�-�c <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 />@T7rall�y <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />CONSTRUCTION <br />Total Depth: <br />(C� Drilling Rig Type: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: d` <br />Depth to Water: �l%� �--�� ��Q �� r� <br />Grout Material: ���:�� �v�`>,� <br />Gallons of Grout Used: <br />❑Well Installation C�/ell Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />YVater <br />allons <br />Cement 471b <br />Baas <br />5°!° 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 />tlBags <br />2.s <br />s <br />1 <br />s <br />l0 <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 />4o <br />so <br />s <br />20 <br />4o <br />s <br />Min 2" Annular EHD Seal Verified: <br />❑ 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 />. iii � <br />�/� ��. <br />:. -. <br />►- :. <br />.. - <br />•• <br />r\ �... <br />tt. <br />3°r° Mix <br />5°!° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />— <br />::¢. <br />_ <br />;;: <br />- <br />;-: <br />— <br />Y.: <br />_ <br />slatted <br />"� <br />sac;aon <br />_ <br />_ <br /><a:. <br />>�• <br />_ <br />�� <br />.. <br />��: <br />_ <br />— <br />;�. <br />-� <br />ft. <br />— <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 />ft. <br />Feet <br />Bentonite/0ement Mix <br />3°r° Mix <br />5°!° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />`J Er -N - Z,� <br />S�. —.5- 2S <br />,5U -S --7; <br />s � - uv zS <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />