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.-..�`-��..'�.. SANyY10AQUIN <br />`" }-�' i • ' COUNTY <br />�^ir _ �.�=� �il'�OLI7f'SS C�(G?'VS IIG'f�. <br />Envir®nmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:2 ��Q \ 2��nspector: <br />Facility Address: l �� �_� <br />Well Address: ��.�� � ��L. <br />W P# �. <br />Soil Boring#: 'S ,_.. �'� <br />Drilling Company: �, <br />Driller Onsite: <br />Consultant: W `F�o�� � <br />Geologist: <br />CONSTRUCTION <br />,u ,per-��,.•�,fi�1Cn�0� Total Depth: <br />Well#: Drilling Rig Type: <br />�So�-�.��oN� <br />Public Water System Onsite: ❑Yes No <br />Domestic Well Onsite: ❑Yes No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <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 Depth:�_ <br />Depth to Water: �— <br />Grout Material: N <br />Gallons of Grout Used: � ��A <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED / <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity <br />f�lTremie <br />❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />3°l° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />;Bags <br />2.4T <br />Thickest <br />Thinnest <br />#Bags <br />2,5 <br />4.T <br />s ! <br />5 <br />10 <br />1 <br />5 <br />1D <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />2D <br />AO <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 />35 <br />70 <br />7 <br />17.5 <br />35 <br />7 <br />40 <br />80 <br />8 <br />2D <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 />_. <br />i .�� �. <br />�r�� ��� <br />_. -. <br />�- _. <br />r� - • <br />i f <br />� � .. <br />�!� - <br />ft. <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 />Screen Feet <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />gentonitelOement Mix <br />3°l° Mix <br />S°�° Mix <br />Bentonite per 4� Ib <br />1.41 <br />2.4T <br />Bentonite per 94 Ib <br />2.82 <br />4.T <br />s ! <br />F <br />i� <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />