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SAN.�.JoAQU■N <br />f.. I iCOUNTY <br />G7r iotn�ss grcl.1s <br />Monitoring <br />Date, A9_/01 <br />Facility Address: <br />Well Address: <br />Environmental Health Department <br />/ell/Soil Boring Inspection Report <br />I CONSTRUCTION <br />otal Depth: 5 , <br />WP# �&,Well#: � i SV "�3�rilling Rig Type: <br />Soil Boring#: - \ ''L_- <br />Drilling Company: <br />Driller Onsite: <br />Consultant: Coo <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 ❑No <br />�pnll r <br />Contamination Noted: ❑Yes ❑ No <br />If yes, spoils storage Location: <br />Covered: El Yes <br />❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />]Boring <br />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 />'Nater <br />allons <br />Cement 94 ib <br />Sa s <br />Thickest <br />Thinnest <br />#Bags <br />4.7 <br />Thickest <br />Thinnest <br />47eags <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 />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 1 <br />40 <br />8�IL <br />40 <br />80 <br />8 <br />in 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: _ <br />❑ Stove Pipe <br />� <br />COMPLETION IChristie Box <br />r• -s a <br />r ..e <br />�s - • <br />s <br />MATERIALS <br />/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Screen <br />Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />Type of Method: <br />E� <br />�Z:sNoia� <br />Im <br />a/Z <br />N sGsY2 le <br />IZ>r <br />Bentonitel�ement I�lix <br />3°�° Ivlix <br />�°�° Mix <br />Bentonite per �� Ib <br />1.41 <br />2.4T <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 />