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SAN.IOAQUIN <br />COUNTY <br />Greatness grows here. <br />Date: <br />Facility Address:_ <br />Well Address: <br />WP# f{2 S <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: _ <br />Consultant: C <br />Geologist: — <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: -SSG' S�� i <br />Well#: sV 2Z-("Zv <br />Svc #L1 -1 t) <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 />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 <br />❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: /✓U CMCO LA f"CVC e <br />Grout Material: 71 e�C -� �•�' <br />Gallons of Grout Used: ^SLS <br />UVell Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />''0 Gravity ❑Tremie ❑Other: <br />ore <br />Water <br />allons <br />Cement 471b <br />Bas <br />5% Mix <br />Water <br />g <br />Izall ons <br />Cement 941b <br />Bags <br />Thickest <br />Thinnest <br />#Bags <br />4.7 <br />Thickest <br />Thinnest <br />#i 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 />1 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 />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 1 <br />40 <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />r <br />Total Depth: <br />Drilling Rig Type: _ <br />Min ! nu ar 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 />u3UVE-GROUND <br />GUMPLEMN <br />❑ Yes El No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />� <br />'Ape <br />�f Ko f <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 />fi. <br />Feet <br />Bentonite/Cement Mix <br />3% Mix <br />5% 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 />