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SAN JUA[�UIN <br />COUNTY <br />�����,Foar'P... Greatness grows mere. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Hata• ����/ �� Incnartnr• �'Uf��C��z� <br />Facility Address: /'Lai, �-• .rt�i �� � 1'4r�. <br />Well Address: <br />wP# � y.�y/9 well#: ��r <br />Soil Boring#: <br />Drilling Company: �C<s�� � <br />Driller Onsite: �'�r�� <br />Consultant: ��� <br />Geologist: �%�i� °� <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 ❑No <br />Verified Chain of Custody: ❑Yes ❑ No <br />SPOILS <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: "7� <br />Grout Material: �✓�� ��� �� <br />Gallons of Grout Used: �: f S� <br />❑Well Installation C�Nell Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity L�Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />5°�° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />tt Bags <br />4.7 <br />Thickest <br />Thinnest <br />ttBags <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 />30 <br />60 <br />6 <br />15 <br />30 <br />6 <br />35 <br />70 <br />7 <br />17.5 <br />35 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CNAIS'iY-80X <br />C:O � �� N COMPLETION <br />c�c�ound s�� <br />a�o�n <br />ft. <br />ft. <br />ft. <br />;: _ � <br />. ,� � <br />>�: � _ <br />�� C <br />O <br />stott�d ��: _--- � <br />:::� — <br />aaC,ion - <br />- � ��+�+ pa�c <br />:�; — <br />.�� — . <br />r2 - <br />�,. <br />.a: _ <br />_...`ft. � _' ft. <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 />Screen <br />Feet <br />BentonitelCement Mix <br />3°f° Mix <br />5°�° Mix <br />Bentonite per 4T 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 I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.slcehd.com <br />