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SAN JOAQUIN <br />COUNTY <br />Gr ni_; aro, ,,._rc. <br />Environmeh _ .al Health Department <br />Monitoring Well/ oil Boring Inspection Report <br />Date: 4 Inspector: n CONSTRUCTION <br />Facility Address: 2t,54�1 <br />Well Address. c�<v,� y -l9 Total Depth: <br />WP# w 1��\ ��� Well#: Drilling Rig Type: <br />Soil Boring#: �j� � ���� 5S � 1 <br />Min 2" Annular EHD Seal Verified: <br />ElDrilling Company: CS Lt4k' <br />Driller OnsiteL)- DS�'G�: <br />Screen Length From: To: <br />: <br />Consultant: ��,�� Filter Pack From: To: <br />Bentonite From: To: <br />Geologist: <br />Grout From: To. <br />NK <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 />❑ Yes 14No <br />Verified Chain of Custody: ❑Yes ❑No <br />Contamination Noted: ❑Yes ❑ No <br />If yes, spoils storage Location: <br />Covered: ❑Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: �� <br />Depth to Water: �\\X <br />Grout Material: N�c,lpc'C �qr Y\j �00q�z <br />Gallons of Grout Used:11 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation )9Boring <br />Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />uallons <br />Cement 471b <br />ea s <br />3°�° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />2.47 <br />Thickest <br />Thinnest <br />#Bags <br />2.5 <br />4.7 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />745 <br />1 15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />125 <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 />735 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />1 8 <br />Yes ❑No <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />HeIgnE <br />RVEodROUND <br />:. <br />COMPLEMN <br />..WPLETION <br />gfout <br />Nam <br />ft. <br />BentonitefOement Mix <br />3°�° Mix <br />�°f° Mix <br />per 47 Ib <br />1.41 <br />2.47 <br />__Bentonite <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />3L <br />�� <br />_ <br />siottgd <br />.;T <br />�� <br />ti:• <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 />art E'. �• <br />Screen <br />ft. <br />Feet <br />_ <br />BentonitefOement Mix <br />3°�° Mix <br />�°f° Mix <br />per 47 Ib <br />1.41 <br />2.47 <br />__Bentonite <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 />