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SAN JOAQUIN Environmental Health Department <br />—COUNTY --- <br />Monitoring Well/Soil Boring Inspection Report <br />Date:e Inspector: <br />Facility Address: fs <br />Well Address: <br />WP# Well#: <br />Soil Boring#: 1Q 19 01� Ea$ <br />Drilling Company: fin/ �2 1 <br />Driller Onsite: 4 w <br />Consultant: k,j,,.& �Xw4'.- tE v1 <br />Geologist: , sap t 6 a <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes 0 N <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 />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <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 ❑ No <br />❑ Yes El No <br />❑ Yes ❑No <br />casing <br />height <br />ABOVE -GROUND GtiRISTY 80X <br />COMPLETION coMPLET]oN <br />t round Swfa . T <br />grout <br />ft. <br />ft. <br />R� <br />= e <br />stottad <br />sawn <br />_ = g -vat pacts <br />GROUTING or DESTRUCTION Total Depth: 0 _IuFb� 24(,(, 304-1 204 <br />Depth to Water: f) 10fb .fir 2.,%ftI r --x• — n - <br />Grout Material: ewjs C.t <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑��Well Destruction Blank Feet <br />❑Boring Installation 26ring Destruction Slot Size: <br />Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />❑ Gravity ❑Tremie ❑Other: Type of Method: <br />Water <br />allons <br />Cement 47 lb <br />Bas <br />Water <br />izallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#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 />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 />� S <br />01 3 <br />10/16/2017 <br />�S�1868 E. Hazelton Avenue I Stockton, F California 95205 1 T 209 468-3420 1 09 464-0138 1 www.sicehd.com <br />