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SANJOAQUIN <br />` ----COUNTY <br />- - <br />S.,r�uN Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: tiktiL,(ZL Inspector: (j " , (. <br />Facility Address: �7-15c <br />Well Address: <br />W P# 41' "l W e I I #: tZi <br />Soil Boring#: I j5 �} (5 L ,(-0 <br />Drilling Company: T.L'J-r'A co V% - <br />Driller Onsite: lr_-,rt-L <br />Consultant: Yid �Crrw C W - <br />Geologist: 'r V- ( ( <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 />❑ Yes LAo <br />❑ Yes An—No <br />Verified Chain of Custody: ❑ Yes ❑No <br />CPr)ll C <br />Contamination Noted: ❑ Yes J90o <br />If yes, spoils storage Location: <br />Covered: ❑ Yes — LJ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: w <br />Gallons of Grout Used: l l 0 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation �oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />'Gravity ❑Tremie ❑Other: <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 />casing <br />TV height <br />ABOVE -GROUND CHRiS'Tr-aox <br />COM?LEfION COMPLETION <br />Ground Surfak. + <br />Grout <br />ft. <br />ft. <br />tt. <br />— o <br />atoned c <br />&*clan — 8 <br />g-vlw Pack <br />ql <br />�j 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 />Water <br />allons <br />Cement 471b <br />Bas <br />water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />11 Bags <br />Thickest Thinnest <br />4Bags <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 />4 <br />20 <br />40 <br />4 <br />12.5 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />s <br />40 <br />so <br />s <br />ft. <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 209 468-34201 F 209 464-0138 1 www.s*cehd.com <br />