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Y. - <br />SAN J0�4Q111N <br />COUNTY <br />Greatr�css yraws lz�:re. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />/ 2 / c %r , <br />Date: -�/ >/ Z � Ins ector: V ��LS ��`'1 � CONSTRUCTION <br />Facility Address: � � � �,. S� S� <br />Well Address: '� <br />WP# d� � 3 ��� We[I#: <br />Soil Boring#: <br />Drilling Company: CG• S CG�- <br />Driller Onsite: <br />Consultant: �� f �� <br />Geologist: <br />Public Water System Onsite: <br />Total Depth: <br />' (� �� Drilling Rig Type: <br />❑ Yes ❑ No <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />Domestic Well Onsite: ❑Yes ❑ No ca�i�g <br />if yes, location and distance: � ���-��� <br />SAMPLING �,�.�R�y� - <br />HoldingTemperature: ��"�'�-•��� c� <br />Method: � �`�"� ,�, <br />Screening Method: atm <br />Verified Chain of Custody: ❑Yes ❑ No �• <br />�_ <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth:�� <br />Depth to Water: � <br />Grout Material: C �/`� � <br />Gallons of Grout Used: •'`- rj SJ G <br />❑Well Installation /ell D�t�Fuct�o"r <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity <br />�Tremie <br />❑Other: <br />U �� <br />�/�ater <br />gallons <br />Cement 471b <br />Bas <br />�°�° Mix <br />Mater <br />gallons <br />Cement 941h <br />Bags <br />Thickest <br />Thinnest <br />it Bags <br />4.7 <br />Thickest <br />Thinnest <br />„Bags <br />2.5 <br />S <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 />3D <br />6 <br />30 <br />50 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />40 <br />80 <br />0 <br />20 <br />40 <br />8 <br />i�_ <br />�°�° Mix <br />�°�° Mix <br />Bentonite per �� Ib <br />1.41 <br />2.h7 <br />Bentonite per 9�41b <br />2.82 <br />4.7 <br />�,; <br />ti� <br />a== <br />3� <br />i' <br />.. <br />a&3r.�i <br />;' <br />as�on <br />f- <br />�: <br />�= <br />-� <br />�. <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 />9 <br />C <br />0 <br />6 <br />.J' <br />;;, x�-s� pack <br />Screen <br />F� <br />Feet <br />>��ntonitef�ement Mix <br />�°�° Mix <br />�°�° Mix <br />Bentonite per �� Ib <br />1.41 <br />2.h7 <br />Bentonite per 9�41b <br />2.82 <br />4.7 <br />10/16/2017 <br />1808 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 (E 209 464-0138 � www.sjcehd.com <br />