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SAN 10AQUIN <br />COUNTY <br />. _. Greatness gro;Vs i5ere. <br />Date: �r � � Z� <br />Facility Address:�l � <br />Well Address:'–�-- <br />Soil Boring#: -- ' <br />Drilling Company: J <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Envir®nmental Health ®epartment <br />Monitoring Well/Soil Boring Inspection Report <br />y /, <br />I Spector: )���/ �'``� CONSTRUCTION <br />��U � <br />Well# <br />,J�'G <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 />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <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 />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:�� � U <br />Depth to Water: '� <br />Grout Material: �`%� �'+� '�^ �`f� �� � � e� <br />Gallons of Grout Used: b9t� �^-�� e� � <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑.Pressure Grout ❑Over Drill <br />�avity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />�°�° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />ttBags <br />4.7 <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 />25 <br />50 <br />5 <br />12,5 <br />25 <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 />COMPLETION <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />_. <br />.� � �Pi'"'a�� <br />s� � i <br />�/� fir, <br />_. -. <br />�- :. <br />�. - <br />�. <br />� .. <br />//. <br />�� <br />ft. <br />8� - <br />.,- - <br />�,. <br />'%r -- <br />stattad y� —' - <br />a�on.:w — <br />?M ..�� - <br />�: _ <br />,:-� — <br />'.�M- .. <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 />0 <br />m <br />a <br />�1 <br />Screen <br />Feet <br />BentonitelOement Mix <br />3% Mix <br />�°�° 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 � www.sjcehd.com <br />