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SAN,J0AQUIN <br />COUNTY <br />Gr :atnet s grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector:ageOEF CONSTRUCTION <br />Facilitv*! <br />\rok Ob'� 3 \l,o <br />Well Address: —� 5 (� �)p*sC F' -� Total Depth. <br />WP# (02. b Well#*%\y 1kV Drilling Rig Type. <br />Soil Boring#: Min 2" Annular EHD Seal Verified: <br />Drilling Company: a LAW) <br />❑ Yes ❑ No <br />Driller Onsite: �+ Screen Length From: To: <br />Consult -ant: wm- k Filter Pack From: To: <br />Geologist: <br />Bentonite From: To: <br />Public Water System Onsite: ❑ Yes ONO <br />Domestic Well Onsite: Yes ONO <br />If yes, location and distance: yL4 lf9� itY� <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 <br />GROUTING or DESTRUCTION Total Death:�i� <br />Depth to Water: �`� <br />Grout Material. c'C <br />Gallons of Grout Used: <br />❑Well Installation Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />�D <br />METHOD USED <br />❑Pressure Grout ❑Over Drill ll r <br />El Gravity OTremie CllOthers %-� <br />Water Cement 471b Water Cement 941b <br />allons Bas allons Bags <br />Thickest Thinnest #Bags Thickest Thinnest #Bags <br />2.5 s 1 s 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12,5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Grout <br />From: <br />To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />ft. _ <br />.A <br />slonad :l <br />stc',iorl <br />fc. <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 />BentonitetOement Mix 3°�° Mix 5°l° Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2082 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 009 468-3420 � F 209 464-0138 � www.sjcehd.com <br />Grout <br />From: <br />To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />ft. _ <br />.A <br />slonad :l <br />stc',iorl <br />fc. <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 />BentonitetOement Mix 3°�° Mix 5°l° Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2082 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 009 468-3420 � F 209 464-0138 � www.sjcehd.com <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 009 468-3420 � F 209 464-0138 � www.sjcehd.com <br />