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SAN JOAQUIN <br />--COUNTY--- <br />- <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 6/iD 1 f irInspector: /UA&Z--,- <br />Facility Address: /,V. 1 wf �% I V—+ A vk <br />Well Address: <br />WP# cc.) b!icz y0 Well#: <br />Soil Boring#: &3 <br />Drilling Company: j<oL�,'z c,,, <br />Driller Onsite: ac)1v.-- <br />Consultant:-�(R-'2 <br />Geologist: PmILn� <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />rnNCTRI IrT1nKI <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />cpnii c <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: t%b <br />Grout Material: N` e,j Ce tu,� <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation PqBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie XOther: 4 �t/ <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 />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRISTY4= <br />WNFLETION COMPLETION <br />Ground Suutacs ...+ <br />grout <br />n. <br />n. <br />n. <br />_ <br />_ o <br />slotted = B <br />"c,jon <br />gravel pack <br />n. =IF n. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />