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SAR JOAQUIN Environmental Health Department <br />4' —COUNTY - <br />09,,,P' Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: `fbglI Fl Inspector: <br />Facility Address: rOSS-� s k,,a W <br />Well Address: <br />WP#cZ) 3� 677 Well#: <br />Soil Boring#: %j Z6 - B y.3 <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />[]Christie Box <br />casing <br />height <br />ABOVE -GROUND Ci¢i M -Sox <br />CONFLETION COWJM--MON <br />Ground Surhos <br />grout <br />tt. <br />tt. <br />tt. _ <br />_ V <br />= e <br />L3 2C)' _ion d <br />El a J`_ r�� t s�c3on _ 4nw1 Parc <br />C3 13 O -� Bi - <br />GROUTING or DESTRUCTION Total Depth: S� g�Z 1Or <br />Depth to Water: IV6 ty+J 8113 51 n- n' <br />Grout Material*'-P-�Cew"cati <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation X Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity I$Tremie Other: <br />/11%te <br />all <br />ent 471 <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest <br />Thinnest <br />9Bags <br />Thickest Thinnest <br />NBags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <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 />t425 a41i,-ri 97 bwSs <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 <br />10/16/2017 <br />F 209 464-0138 1 www.s'cehd.com <br />