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SQN_JOQQUIN Environmental Health Department <br />—COUNTY— <br />' <br />;.,ar: ureotriess yrorvs Fete. <br />Mon`ito�ring Well/Soil Boring Inspection Report <br />Date: ti L4 Inspector: Vv CONSTRUCTION <br />FaciIityAddress: I !fo Aj- �r �'� 5,�v' <br />Well Address: Total Depth: 1 <br />Lt- <br />WP#___Zr, [ Well#: Drilling Rig Type: <br />Soil Boring#: _ 3�12' �f Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Drilling Company:*Z'Zx� <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: <br />❑ Yes ?119 <br />Domestic Well Onsite: <br />❑ Yes )4No <br />If yes, location and distance: <br />�� <br />SAMPLING <br />#Bags <br />Holding Temperature: <br />lJBags <br />Method: <br />5 <br />Screening Method: <br />5 <br />Verified Chain of Custody: ❑ Yes ❑No <br />MM4,1110 <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />GROUTING or DESTRUCTION Total D IV,epti,. t 6� I v l7 <br />Depth to Water: z <br />Grout Material: C <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />lJBags <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 />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 <br />40 <br />8 <br />40 <br />80 <br />8 <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 />ft. <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />c�J <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sucehd.com <br />