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�u, <� <br />L_��; �,. <br />.�__ �>"- <br />SAN JUA[�UIN <br />COU NTY- <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: � ���rz Inspector: !'✓� ���`�" <br />Facility Address: �'Z a k� � �1d,�� �� ���� <br />Well Address: <br />WP# �� `�� �'T Well#: �'►')�,-,Z <br />Soil Boring#: <br />Drilling Company: L�s����e <br />Driller Onsite: �tt''� <br />Consultant: I�T� <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 />❑ 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 De�th: <br />Depth to Water: � ��� ���f Z `� <br />,� �� � � <br />Grout Material: ��1 ,Cera•-�� <br />Gallons of Grout Used: � Z� S��)�t 0f1� <br />❑Well Installation <br />��,,//'' <br />L�Well Destruction <br />❑Boring 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 />5% Mix <br />Water <br />allons <br />Cement 941b <br />ea s <br />Thickest <br />Thinnest <br />#Bags <br />2.82 <br />Thickest <br />Thinnest <br />#Bags <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 <br />40 <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION <br />❑ Stove Pipe ❑Christie Box <br />• �► ii � <br />�' �_`�!\ <br />�/� Vii. <br />:. - . <br />�- :. <br />«. - <br />.. <br />l <br />�� <br />ft. <br />3°l° Mix <br />5% Mix <br />Bentonite per 4T Ib <br />1.41 <br />2.47 <br />Bentonite <br />per 94 Ib <br />2.82 <br />4.7 <br />:��� <br />_ <br />— <br />�; <br />sAc',ion <br />_ <br />a: <br />_ <br />:�:� <br />- <br />�� <br />_ <br />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 />r� r^ <br />Screen <br />ft. <br />Feet <br />BentonitefCement Mix <br />3°l° Mix <br />5% Mix <br />Bentonite per 4T Ib <br />1.41 <br />2.47 <br />Bentonite <br />per 94 Ib <br />2.82 <br />4.7 <br />�1s� lam'-�=� �c��� <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />