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SAN,, Environmental Health Department <br />COUNTY <br />f�R <br />°�crFoa Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: TZ Inspector: <br />Facility Address: i ©ol ✓ �')'1 St., <br />Well Address: <br />WP# U Well#: <br />Soil Boring#: — <br />Drilling Company: ex, <br />Driller Onsite: ! e- <br />Consultant:eK 7 eqjj&y <br />Geologist: SGtrc--K <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 ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: ISO/ <br />Depth to Water: 1 11 ) i/ <br />Grout Material: .77P,,, c. <br />Gallons of Grout Used: SU <br />❑Well Installation ❑Well Destruction <br />El Boring Installation 14oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity *remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />411 Bags <br />Thickest Thinnest <br />HBags <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 />is <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 />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 />rnKADl FTIMU <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />El Christie Box <br />casing <br />height <br />ABOVE -GROUND ctlRlsrr aox <br />COMPLETION CCMPLEnON <br />Grourd surras. <br />01 grout <br />�ft. <br />tt. <br />ft. <br />0 <br />— o <br />slatted = c <br />sac5oni = B <br />9-1 lack <br />tL = ft. <br />MATERIALVDEVELOPM ENT <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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />