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SAN JOAQUIN Environmental Health Department <br />�Q i= ----COUNTY--- <br />0 <br />Greori7ess yru.- <br />Monitoring Well/Soil Boring Inspection Report <br />Date: .2X21 Inspector: <br />Facility Address: ,�.,�C� t.1;. �{ar �•h �� rnlc+� <br />Well Address: <br />WPH CV y/ Well#: r )w —2 <br />Soil Boring#: <br />Drilling Company: .5141: Z4.( A)ro ee6 <br />Driller Onsite: > <br />Consultant: Ac ✓wined �v ' <br />Geologist: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />connai inir <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: F-1 Vac <br />SPOILS <br />❑ Yes ❑No <br />❑No <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 />5 � <br />Depth to Water: AV <br />Grout Material: 11/24 leeirwo <br />Gallons of Grout Used: <br />❑Well Installation i <br />WeII Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED ` <br />❑Pressure Grout IJOver Drill <br />❑ Gravity IlTremie ❑Other: <br />ateri <br />allo <br />nt 471b <br />B <br />5% <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />4Bags <br />4.7 <br />Thickest <br />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 />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 />.0 - :. <br />COMPLETION <br />ft. <br />3% Mix <br />5% <br />Bentonite per 47 Ib <br />1.41 <br />.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />= <br />slotted <br />sac9cn <br />= <br />= <br />.. <br />it. <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 />cn�.+ pack <br />tt. <br />Screen <br />Feet <br />Bentonite/Cement Mix <br />3% Mix <br />5% <br />Bentonite per 47 Ib <br />1.41 <br />.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />��0 <br />1868 E. Hazelton Avenue I Stockton, California 95405 1 1 209 468-3420 I F 209 464-0138 1 www.sicehd.com <br />