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SAN zd0AQUIN <br />`W11; L}~;' COUNT Y <br />i� F` C7i"P,Oii1cSS gr0'.'�s here. <br />Environmental Health Department <br />Monitoring Well Soil Boring Inspection Report <br />I �K <br />Date: CJ C ?h Inspector: U y�CONSTRUCTION <br />Y <br />I u I�� -K� �tTiz <br />Facilit Address: <br />Well Address. <br />WP# 000,552- Well#: <br />Soil Boring#: <br />Drilling Company: awe T ltcJ-y <br />Driller Onsite: _�J fir✓) <br />Consultant: Avtli L^^wCeaoe( mV <br />Geologist: li-1 Y G A4. 1, iii <br />Public Wafter System Onsite: <br />Domestic Well Onsite: <br />If yes, location and disfiance: <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 />Total Depth: <br />L Drilling Rig Type: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 1 <br />Depth to Water: <br />Grout Material: ern: e/q►- <br />Gallons of Grout Used: 2v Gid' 04 <br />❑Well Installation ❑Well Destruction <br />]Boring InstallationU <br />Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �kTrem <br />ie ❑Other: <br />Water Cement 471b Water Cernent 941b <br />allons Bas all <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />❑ Yes ❑No <br />From: To: <br />From: To <br />m : <br />Fro: To. <br />From: To. <br />❑ Stove Pipe ❑Christie Box <br />tt, <br />a� <br />�iCil.�ttf is <br />l3L'�70n <br />s� <br />#t, <br />MATERIALS/ <br />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 />erdgg Vie <br />O 1Fps � <br />Screen <br />Feet <br />�entonitel�ement ttAix <br />3°�° Itllix <br />ons <br />Ba s <br />Thickest <br />Thinnest <br />It Bags <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 />IQ. <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 />25 <br />50 <br />5 <br />1245 <br />25 <br />5 <br />15 <br />30 <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 />20 <br />40 <br />8 <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />❑ Yes ❑No <br />From: To: <br />From: To <br />m : <br />Fro: To. <br />From: To. <br />❑ Stove Pipe ❑Christie Box <br />tt, <br />a� <br />�iCil.�ttf is <br />l3L'�70n <br />s� <br />#t, <br />MATERIALS/ <br />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 />erdgg Vie <br />O 1Fps � <br />Screen <br />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 />�entonitel�ement ttAix <br />3°�° Itllix <br />S°fes Nlix <br />Bentonite per �� Ib <br />1.4'1 <br />2.4 f <br />Bentonite per 94 lb <br />2082 <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 />