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_ _��-- ;: <br />�.. C` .. -.` \4_.: <br />-..SC.:cG� �'..: <br />SAN JOAQUIN <br />-- C O U f J T Y ---- <br />Cil i'Utf7 S� yr t)'>1'S f3tf '. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: � '� �' �� � Inspector: c�1y� <br />Facility ddress:��, � ��_�,4�� y V'� <br />Well Address: <br />WP# hi �2 '� � Well#: <br />Soil Boring#: - <br />Drilling Company: �CUI��, <br />Driller Onsite: <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 />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth:-�- <br />Depth to Water: <br />Grout Material: � <br />Gallons of Grout Used: r, r `� n <br />❑Well Installation ❑Well Destruction � <br />❑Boring Installation �I�,Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />G�1 Gravity <br />®Tremie <br />,� _ ,\ <br />❑Other: <br />Y'dater <br />gallons <br />ma_nt �?Ib <br />gags <br />cr�;srr-aox <br />t;Vater <br />+gallons <br />cement 941b <br />ga s <br />Thickest <br />Thinnest <br />� Bags <br />CC`MPLE'iION <br />TI.7i�kest <br />Tl��innest <br />� gags <br />2,5 <br />5 <br />1'r <br />5 <br />10 <br />1 <br />5 <br />1U <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />'SO <br />3 <br />10 <br />20 <br />A <br />20 <br />40 <br />4 <br />?5 <br />50 <br />5 <br />12,5 <br />25 <br />5 <br />15 <br />SO <br />6 <br />30 <br />EO <br />6 <br />35 <br />70 <br />? <br />1?.5 <br />35 <br />? <br />40 <br />SO <br />5 <br />20 <br />40 <br />S <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 />COMPLETIO <br />❑ Stove Pipe ❑Christie Box <br />ABt�Y�-� R CtJND <br />casing <br />height <br />tt. <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 />��ype of Method: <br />.� <br />Screen <br />tt. <br />Feet <br />BentonitelGement Mix <br />3% Mix <br />cr�;srr-aox <br />cot�t.FrtoN <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />CC`MPLE'iION <br />ground <br />Surfxs ....� ......._ <br />procrt <br />n. <br />tt. <br />t -t. <br />>� <br />— <br />a <br />_ <br />c <br />0 <br />: to clad <br />:. <br />— <br />.:�. <br />— <br />sacion <br />— <br />.� <br />_ <br />� <br />sx��+ � <br /><:k: <br />��ik <br />�, <br />:.-� <br />-- <br />tt. <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 />��ype of Method: <br />.� <br />Screen <br />tt. <br />Feet <br />BentonitelGement Mix <br />3% 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 />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />