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SAN JOAOUIN <br />--COUNTY <br />°,cro app Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: j g Inspector: 674-0; ✓Le- CONSTRUCTION <br />Facility Address:o1( ,n . Zc t(,( r�a►� (zd . <br />Well Address: Total Depth: <br />WP# 003<�q )'1 Well#: Drilling Rig Type: <br />Soil Boring#: j22 -13Min 2" Annular EHD Seal Verified <br />Drilling Compan i (Q-_7;� C <br />Driller Onsite: Dctu l7 d 0.v1 vt Screen Length From: <br />Consultant: c i ylozv'I h Filter Pack From: <br />Geologist: EyaM Bentonite From: <br />Grout From: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />cnnnoi Mie <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 />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes 1:1 No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 0 e <br />Grout Material: �QGt- 6eti✓Ler� <br />Gallons of Grout Used: 55 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation)Ooring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Fremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gall ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnes <br />N <br />Thickest Thinnest <br />rt 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 />❑ Yes 11 No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />A OVE-GROUND C4iRiSTY43OX <br />COMPLETION COMPLETION <br />Ground Surface <br />grout <br />�- ft. <br />ft. <br />tt. <br />a; <br />vZ = <br />it — • <br />s <br />_ a <br />alottad <br />sacdon <br />craw+ Pact <br />2_ <br />MATERIALS/DEVELOPM 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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />