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-YI III, <br />..PC <br />SAN Y=JOAQUIN <br />COUNTY <br />rZ rEcllness Grows here. <br />Environmer I Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: \A'Vo 'Wl,\ Inspector. Q�2 <br />Facility Address: \o02. \wW m yCcA%mm:)p <br />Well Address. <br />WP# �Well#: <br />Soil Boring#: 1 P� <br />Drilling Company: _ r ec.�P�v0 _ <br />Driller Onsite: --�\,(.-., <br />Consultant: � � <br />Geologist.. <br />Public Water System Onsite: ❑Yes L�No <br />Domestic Well Onsite: ❑Yes CI,Vo <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 />❑ Yes ❑No <br />If yes, material: C�y���Q W.9�' . <br />GROUTING or DESTRUCTION Total Depth: v 5t <br />Depth to Water: ^ tjoo <br />Grout Material: tJSr� Llqr�,n,�.-��' <br />Gallons of Grout Used: 5 L.O <br />,Well Installation <br />METHOD USED <br />Li Pressure <br />❑Well Destruction <br />❑Boring installation ❑Boring <br />Destruction <br />Grout ❑Over Drill <br />❑ Gravity [�Trem <br />ie ❑Other: <br />CONSTRUCTION <br />Total Depth: C70 <br />Drilling Rig Type:e�o�p�ts <br />Min 2" Annular EHD Seal Verified. Yes ❑No <br />Screen Length From: \\�h F �`'�� To:12,4� �p <br />Filter Pack FromajIS7 To: 0 ° 0 <br />Bentonite From:' k10 To:_ \ASO b S <br />Grout From: To. gip` b6v� <br />COMPLETION El Stove Pipe Christie Box <br />casinr� � - <br />. height . <br />ABOVE-dROUND C#-iASSiPT'�-8C3�C <br />CQi�Pi'=7�oN coLEncr� <br />ckwnd Sul Of <br />�fte <br />mrotd <br />S� n. <br />A <br />w 14 <br />daco <br />_ _ o <br />slonad <br />3�0t1 ••;i- `� <br />9M� Pack Mfte <br />Q <br />/VVVL c, f� wror V GvA4 Ov6?T%VN• <br />MATERIALS/DEVELOPMENT <br />Casiri Tvpe: C 2 C C44 <br />nk Feet Screen Feet <br />Water <br />allons <br />Cement 47Ib <br />Bas <br />3°�° Nlix <br />Nater <br />alions <br />Cement 941b <br />Ea s <br />Thickest <br />Thinnest <br />#tSags <br />Thickest <br />Thinnest <br />#Bags <br />5 <br />2082 <br />4.7 <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 1 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 lr�40 <br />80 <br />8 <br />Bla <br />Slot Size: <br />as <br />of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: S W�JC> <br />Type of Method. <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />r <br />Cry. <br />oN� <br />BentonitefOement t�fi� <br />3°�° Nlix <br />S°l° �"x <br />Bentonite per 4� Ib <br />1.�1 <br />2 <br />Bentonite per 94 Ib <br />2082 <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 />r <br />Cry. <br />oN� <br />