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SAN 1DAQUIN <br />COUNTY <br />Greatness grows here. <br />Date: 2)* 2 <br />Facility Address: <br />Well Addres: <br />WP# 00 <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant <br />Geologist: <br />Inspe <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Well#: J -I r <br />Total Depth: <br />�3�,6�) Drilling Rig Type: <br />�0 <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 <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Groui <br />❑Well Installation Nell Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />�avity �remie ❑Other: <br />❑ No <br />}Nater <br />allons <br />Cement 471b <br />Bas <br />3°l° fulix <br />Vtater <br />allons <br />Cement 941b <br />Bads <br />Thickest <br />Thinnest <br />#Bags <br />Thickest <br />Thinnest <br />"gags <br />2.5 <br />5 <br />1 <br />S <br />1D <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />1S <br />30 <br />3 <br />7.5 <br />1S <br />3 <br />2D <br />40 <br />4 <br />10 <br />20 <br />4 <br />1?.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />30 <br />60 <br />6 <br />15 <br />30 <br />6 <br />3S <br />70 <br />7 <br />17.5 <br />35 <br />7 <br />40 <br />80 <br />$ <br />20 <br />40 <br />$ <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />caainc� <br />�eS.gizt <br />TliaN <br />t'xirxi Scala" .�—.--�--- <br />ptrxrt <br />lowwPoomat <br />Ito <br />Ii. <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�emen# tvlix <br />3°l° fulix <br />a°I° fvlix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />s <br />slot's <br />' <br />:fr <br />e< <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 />10/16/2017 <br />1808 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 ( F' 209 464-0138 � www.sjcehd.com <br />Bentonitef�emen# tvlix <br />3°l° fulix <br />a°I° fvlix <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 />1808 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 ( F' 209 464-0138 � www.sjcehd.com <br />