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SAN JOAQUIN <br />- COUNTY <br />`OgcoP�`P' Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: cl'� "'—� Inspector: AA S "� <br />Facility Address: IMI /ivtxte"&e.- ST'_..' <br />Well Address: <br />WP#��n�{3il WeII#: <br />Soil Boring#: 13 -Ig <br />Drilling Company: Hca I),& <br />Driller Onsite: Mt` c e <br />Consultant: kl�te I dPy <br />Geologist: S rd i" <br />Public Water System Onsite: ❑ Yes <br />Domestic Well Onsite: ❑ Yes <br />If yes, location and distance: <br />El No <br />❑No <br />SAMPLING <br />Holding Temperature: <br />Cement 941b <br />Bags <br />Method: <br />4Bags <br />Screening Method: <br />uBags <br />Verified Chain of Custody: ❑ Yes <br />❑No <br />SPOILS <br />5 <br />Contamination Noted: ❑ Yes <br />El No <br />If yes, spoils storage Location: <br />10 <br />Covered: ❑ Yes <br />❑ No <br />If yes, material: <br />2 <br />GROUTING or DESTRUCTION Total Depth: I S� <br />Depth to Water: ZZ 1 <br />3 <br />Grout Material: nlQi,T ce"ywe <br />30 <br />Gallons of Grout Used: <br />10 <br />❑Well Installation ❑Well Destruction <br />4 <br />❑Boring Installation 4oring Destruction <br />40 <br />METHOD USED <br />12.5 1 <br />❑Pressure Grout ❑Over Drill <br />5 <br />❑ Gravity U(Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Rallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />uBags <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 1 <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 1 <br />40 <br />a <br />40 <br />80 <br />s <br />IZ bv!" . <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 />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 />