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'(��` SAN JUA[JUIN <br />r.� Environmental Health Department <br />i" I`SI�.�' —COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: L1y to Inspector: NASEEAA <br />Facility Address: 26cz) w H uerv�A,r- <br />Well Address: <br />WP# 0D37427 Well#: <br />Soil Boring# 6&e1•►/ (,f 7. <br />Drilling Company: 4A) <br />Driller Onsite:�+IE <br />Consultant: ,�le.h�l/ol�f, �•aG <br />Geologist: /UlliiaGrrr 1 <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <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 1XNo <br />❑ Yes CZNo <br />❑ Yes El No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />r <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: No Ga/ <br />Grout Material: N&,jf- re,jj,.w t, <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation 5&Boring Destruction <br />nnrrunn i icrn <br />❑Pressure Grout []Over Drill <br />❑ Gravity ❑Tremie Anther: flye /4// <br />Water <br />gallons <br />Cement 471b <br />Ba&sallons <br />Water <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />»Bags <br />Thickest Thinnest <br />41 Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />10 <br />20 <br />2 <br />7.5 <br />15 <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 />1 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 From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />tt, <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 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />APjj://o'. 1 ��s C - <br />be ewe 10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slceh_d.com <br />