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° SAN JUMIN <br />Environmental Health Department <br />—COUNTY— <br />.;_, ' Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Z / zelIV Inspector: A�-4SMAt <br />Facility Address: Z(om W `1oae n— f - 64 - <br />Well Address: <br />WP#_0037IZI V Well#: <br />Soil Boring#: K8 2, 963 <br />Drilling Company: Va �) <br />Driller Onsite: &5`'44/k <br />Consultant: -t,C <br />Geologist: -p1?,." y <br />Public Water System Onsite: ❑ Yes )?No <br />Domestic Well Onsite: ❑ Yes ;RNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: ❑ Yes El No <br />conic c <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes El No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 15" <br />Grout Material: A1Aq-� Ctm,-srz� <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation JXBoring Destruction <br />METHOD USED <br />&ressure Grout ❑Over Drill <br />❑ Gravity A�Tremie ❑Other: <br />Water <br />gallons <br />From: <br />Cement 471b <br />Bas <br />Filter Pack <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ri Bags <br />Thickest Thinnest <br />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 />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 />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <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 />T <br />ABOVE -GROUND C#iAfSiY 60X <br />COMPLETION COMPLETION <br />around surface <br />grout <br />ft. <br />ft. <br />O <br />— o <br />siostad <br />sac5on <br />MATERIALVDEVELOPM ENT <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 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />43 15 104P 10/16/2017 <br />µma <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s[cehd.c_om <br />