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�'�°r=-� � S A N J U A C� U I N <br />z <br />'�� ". 2� <br />���t"���H � COUNTY <br />`�°`�,�r � Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ���/z � Inspector: �,� �'� <br />Facility Address: 1�Zt"1(t� �`/✓��rv�i �-c:�� <br />Well Address: <br />Soil Boring#: <br />Drilling Company: � c7-�'�� � <br />Driller Onsite: <br />Consultant: /�i- �rS�i�%"� <br />Geologist: �IC��" <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 epth: �S�-� <br />De th to Water: �i � � <br />p <br />Grout Material: �0��,' <��,�� � <br />Gallons of Grout Used: /.�� ,S'�//cis- <br />❑Well Installation C�JWeII Destruction <br />❑Boring Installation i��oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />ea s <br />5% Mix <br />Y1+ater <br />allons <br />Cement 941b <br />ea s <br />Thickest <br />Thinnest <br />riBags <br />4.7 <br />Thickest <br />Thinnest <br />iteags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />— <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />.,: <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 />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 />COMPLETION <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />. . <br />�������� <br />�� �1, <br />:. -. <br />�- :. <br />«. - <br />� .. <br />�� <br />ft. <br />3°I° Mix <br />5% Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />::.� <br />— <br />.,: <br />— <br />slotwd <br />�. <br />_ <br />' <br />r�� <br />_ <br />sac'Jon <br />_ <br /><�:: <br />— <br />�� <br />— <br />.r. <br />:a: <br />'� <br />_ <br />it. <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, <br />m <br />m <br />0 <br />Screen <br />tt. <br />Feet <br />Bentonite/Gement Mix <br />3°I° Mix <br />5% Mix <br />Bentonite per 47 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 � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � wvvw,s�cehd.com <br />