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'' COUNTY <br />.-._._ Gr::arr��_s arol^rs mere, <br />Envir®nmental Health ®epartrrient <br />Monitoring Well/Soil Boring Inspection Report <br />Date: � 1 M� 2� Inspector: <br />Facility Address: s2-2 �'" Llto�7� N`,R�F-� <br />Well Address: � � � <br />WP# �.�ble" l Well#: N,�� <br />Soil Boring#: �j�-�-r 5.�� , S ZA <br />Drilling Company: '� ��,�LO� <br />Driller Onsite: (� ��(�-� . <br />Consultant: �',�i�1-c:�tJ �, � �, <br />Geologist: �(����_�- S C E LL A <br />CONSTRUCTIO <br />�z-%.`a � <br />Total Depth: <br />Drilling Rig Type: <br />Public Water System Onsite: ❑Yes C�No <br />Domestic Well Onsite: Yes ❑No <br />If yes, location and distance: � �bb� <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />cpnii � <br />Contamination Noted: 'C`QjD <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑Yes ❑ No <br />❑Yes ❑ No <br />Yes ❑No <br />� % � <br />GROUTING or DESTRUCTION Total Depth: �� ���, � S <br />Depth to Water: � � <br />Grout Material: �/� <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation [Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity <br />L�Tremie <br />❑Other: <br />vl+ater <br />�ailons <br />cement 471b <br />Bas <br />S°�° Iblix <br />+Nater <br />aligns <br />cement 9�Ib <br />Ea s <br />Thickest <br />Thi est <br />#Bags <br />4.T <br />Thickest <br />Thinnest <br />�iBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />3 <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 />5D <br />5 <br />15 <br />30 <br />6 <br />30 <br />50 <br />6 <br />35 <br />70 <br />7 <br />17.5 <br />35 <br />'� <br />40 <br />80 <br />8 <br />20 <br />40 <br />$ <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑ N o <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />using . <br />height <br />,�I30�-GRt�i,1ND C#�3Fi15TY-8�;. <br />co;��z'x�r� c��ci~s <br />Groc+r�d S�rfxs <br />prozrt <br />n. <br />t�. <br />ft. <br />—_. <br />�r � <br />.ax _ ss <br />;�: —"' <br />._.: _ <br />�taYi�d y� —' _ <br />.:.:- ,� <br />3�on - <br />�� � <br />:Y: <br />�y� �� <br />�, � = fi. <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 />Bentonitef�Gement tVli� <br />3°l° lfulix <br />S°�° Iblix <br />Bentonite per 4� Ib <br />1.41 <br />�.�'� <br />Bentonite per �4 Ib <br />2.82 <br />4.T <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />