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SAN <br />—COUNTY— <br />Greatness <br />Environmental Health Department <br />COU NTY— <br />Greatness grn:+s here. <br />MonitoringVWell/Soil Boring Inspection Report <br />Date: Z Z Inspector: CONSTRUCTION <br />Facility Address: <br />Well Address: 2 �3y JfOG ��✓� ' �, Z� <br />W P# 00 "% M6- Well#: <br />Soil Boring#: <br />Drilling Company: a kdepo, <br />Driller Onsite: ��� ey <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes []No <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: ❑ Yes El No <br />CV H.l102V <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: / <br />Depth to Water: <br />Grout Material: lo,3 <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />nnCTunn i 1CCn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity >kfremie ❑Other: <br />Water <br />gallons <br />From: <br />Cement 471b <br />Bas <br />Filter Pack <br />Water <br />Raill ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />2.5 — 5 <br />4Bags <br />- - ---1 — <br />Thickest Thinnest <br />5 -- --10 <br />#Bags <br />-- i -- - <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 />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 />n <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 <br />Bentonite per 47 Ib <br />3% Mix 50% <br />1.41 <br />Mix <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com <br />