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SAN,JOAQUIN <br />COUNTY-//__._.... <br />lJltOtil:'$S Cif OLY'S <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: b 2 2 Inspector: GNB nc <br />Facility Address: ^ iJ W O>_ <br />Well Address: <br />WP# . Well#: <br />Soil Boring#: 7�D\_k T) 5 <br />Drilling Company: \Ij r <br />Driller Onsite: �( <br />Consultant: - i1%CtS <br />Geologist: ` <br />Public Water System Onsite: ❑ Yes El 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 EJ No <br />cpnn c <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: \ v' <br />Grout Material: yj C� <br />Gallons of Grout Used: 'Lumx <br />11) <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ZBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />From: <br />Cement 471b <br />Bas <br />Water <br />gallons <br />From: <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />0Bags <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 1 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 1 <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 />ABOVE -GROUND CHRM Y43OX <br />COMPLETION COMPLETION <br />Groundsutace -+ <br />grout <br />tt. <br />n. <br />dotted <br />sec�on — 3 <br />_ = gravel pack <br />tt.F = ft. <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 />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 />