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I/�r'-J�, SAN5J0AQUIN <br />�� ����.• . Environmental Health Department <br />'ri;::.:: —COUNTY <br />�.= Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: \ I 1 101% Inspector: <br />Facility Address: OL;? <br />Well Address: <br />WP# <br />Well#: NALA) , 9b <br />Soil Boring#: <br />Cement 941b <br />Bags <br />Drilling Company:��S_ <br />#Bags <br />Driller Onsite: <br />#Bags <br />Consultant: Ooh <br />5 <br />Geologist: L-'- . Zf" <br />5 <br />10 <br />1 <br />Public Water System Onsite: <br />/Yes ❑No <br />Domesl�W6ell On e 83 ❑ Yes ;dNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody <br />SPOILS <br />Contamination Noted <br />❑ Yes ❑No <br />❑ Yes ZN o <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height , <br />ABOVE -GROUND CHRZ- Y -Box <br />COWLEDON COMPLETION <br />Groc;rd Sutacs . + <br />grout <br />ft. <br />T_1 -�7 V- <br />ft. <br />o <br />If yes, spoils storage Location: <br />soon" _ <br />Covered:/es ❑No _ <br />qm'-w Pack <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: Z' is. <br />Grout Material: �APc< C C-��c1� <br />Gallons of Grout Used w �-J-P-- d MATERIALS/DEVELOPMENT <br />c Casing Type: <br />❑Well Installation /Well Destruction Blank Feet Screen <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity COTremie /Other: <br />Water <br />allons <br />Cement 471b <br />Water <br />Rallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest 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 />35 <br />70 <br />7 <br />20 <br />4 <br />8 <br />40 <br />80 <br />8 <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 />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 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br />