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/:�''j`'�, �=�� SAN JOAQUIN <br />f`�i�i: _ �� --COUNTY <br />j� i <br />-+� ;�' / <br />``'�sr,F,;����•' Greotness grows herF. <br />Date: <br />Facility Address: i <br />Well Address: <br />WP# <br />Soil Boring#: M <br />Drilling Company: _ <br />Driller Onsite: "I <br />Consultant: –�'I <br />Geologist: � �, <br />►�,II ������e� . <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: �� ti (/�,(%t,� CONSTRUCTION <br />_ Total Depth: <br />Drilling Rig Type: <br />i Q 7.�V � �.� �1f tG F� r � G �`i G� �� i <br />Mln 2" Annular EFiD Sea Verified: <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 />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: '� . <br />Depth to Water: <br />Grout Material: <br />Gallons of Groui <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction ��� � <br />���� <br />METHOD USED <br />❑Pressure Grout ❑Over Drill �,j� � � ��� <br />'r <br />❑ Gravity f�Tremie ❑Other: <br />-� <br />Water <br />allons <br />ment 471b <br />Bas <br />5°!° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />gs <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 />3d <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />40 <br />$0 <br />8 <br />ZO <br />40 <br />$ <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />` Z c i'���-lAlj <br />I1.1 � � (J <br />❑ Yes ❑ No <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />_. <br />i .ii � <br />. i �/� films• � <br />�� � \ �` � <br />:. -. <br />�� <br />�- :. <br />.. - <br />�. <br />•- <br />//. /. <br />`u e <br />ft. <br />-,<,: _. <br />��: _ <br />.,�. — <br />.K 1 <br />abttQd y• _ ' <br />.:o;. — <br />..� _ <br />:� — <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 />Screen <br />tt. <br />Feet <br />BentonitefCement Mix <br />3% Mix <br />5°!° Mix <br />Bentonite per 4� Ib <br />1.41 <br />2.47 <br />Bentonite <br />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 />