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Y-c-Xiic <br />SANJOAQUIN <br />—COUNTY- Environmental Health Department <br />rq :� Greotness grors fiErt. <br />Monitoring Well/Soil Boring Inspection Report <br />Date:/19 Inspector: <br />Facility Address: i <br />Well Address: <br />WP# Well#: <br />Soil Boring#: s <br />Drilling Company: <br />Driller Onsite: C'�� <br />Consultant: �/— rhe –,,IV <br />Geologist: <br />Public Water System Onsite <br />❑ Yes <br />Z <br />Domestic Well Onsite: <br />❑ Yeslo <br />If yes, location and distance: <br />to+ <br />b <br />_h Wu lu �ny <br />v,) pv.5-CrV� <br />Bentonite <br />9Bags <br />SAMPLING <br />BBags <br />Holding Temperature: <br />5 <br />Method: <br />5 10 <br />Screening Method: <br />5 <br />Verified Chain of Custody: ❑ Yes 11 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 De th:_t_ <br />Depth to Water: . `7 t <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity-.ZTremie ❑Other: <br />Water <br />allons <br />From: <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Jhinnest <br />Bentonite <br />9Bags <br />Thickest Thinnest <br />BBags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 1 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 1 <br />35 <br />7 <br />35 70 <br />7 <br />20 1 <br />40 <br />8 <br />40 80 <br />8 <br />01 <br />CONSTRUCTION <br />Total Depth:. / , � � / 1 <br />Drilling Rig Type: .4 l <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />OONFLETION :. <br />j <br />r\ <br />jq' .'s <br />63 <br />Is Ct <br />atoned <br />sacdon = <br />9-01 Pad, <br />AQ <br />M IF <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 />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1 1.411 2.47 <br />Bentonite per 94 lb 1 2.821 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />