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SAN JOAQUIN <br />" ! <br />—COUNTY — <br />�gcfFoaT Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: //'1--�11!Z/ Inspector: /Irncre n <br />Facility Address: <br />Well Address: <br />WP#db 4, ge, Well#: <br />Soil Boring#: -42- <br />Drilling <br />ZDrilling Company: eal- COui-I ew- <br />Driller Onsite: <br />Consultant: _ eo <br />Geologist: 6y <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 />conn c <br />Contamination Noted: <br />If yes, spoils storage Location: <br />❑ Yes ❑ No <br />❑ Yes []No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 0�1 <br />Depth to Water: NDS 6' <br />Grout Material: e20w1G <br />Gallons of Grout Used: <br />❑Well Installation ❑//Well Destruction <br />❑BlYl <br />oring Installation Boring Destruction <br />METHOD USED <br />❑/Pressure Grout ❑Over Drill <br />QGravity ❑Tremie ❑Other: <br />Water <br />allons <br />From: <br />Cement 47 lb <br />Bas <br />Filter Pack <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <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 />ys is <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 CH iSrr-aox <br />COM?LETION COMPLETION <br />Ground Surlacs <br />grout <br />n. <br />n. <br />n. <br />K O <br />_ o <br />slotted —c <br />on — B <br />gravel pack <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 />