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SANr�,JOAOUIN <br />t �'Ni COUNTY <br />_r-�' { Qea-tne5s grows here., <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: D Is�ZI Inspector: �U00f <br />Facility Address: j �(7 t . 27VY) <br />Well Address: <br />WP# �� L o� Well#: <br />Soil Boring#: <br />Drilling Company.� <br />Driller Onsite: <br />Consuitani <br />Geologist: <br />CONSTRUCTION <br />Total Depth: <br />I� Drilling Rig Type: <br />i lei <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 />GROUTING or DESTRU <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑ Yes <br />❑ Yes <br />❑No <br />❑No <br />❑ Yes ❑No <br />❑Well Installation it Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />ravity <br />❑Tremie ❑Other: <br />Water Cement 471 <br />allons <br />b <br />Bas <br />3°�°11�ti� <br />Water <br />allons <br />Cernent 941b <br />Ba s <br />fTh,fckestjThinnest <br />9Bags <br />Thickest <br />Thinnest2.5-- <br />— <br />--- <br />5 <br />-- — 1 <br />5 <br />10 <br />i ---- <br />5 <br />10 <br />-- <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />8 <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 <br />40 <br />8 <br />40 <br />80 <br />8 <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite From: <br />Grout <br />COMPLETION <br />rom: <br />❑ Sfiove Pipe <br />aas�.xig <br />Yieight . <br />comptEnoN <br />Grorina $Waco <br />J <br />€t. <br />To: <br />❑Christie Box <br />rm <br />r: <br />MATERIALSIDEVELOPMENT <br />F <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 />Feet <br />10/16/2017 <br />'1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-038 � www.sjcehd.com <br />�l!en77tr/o))n++itefG�m�nt 1�1ix <br />3°�°11�ti� <br />5�,�¢}Mi� <br />Bentonite per 94 IIS <br />2.82 <br />4.7 <br />10/16/2017 <br />'1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-038 � www.sjcehd.com <br />