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SAN JOAQUIN <br />COUNTY <br />Greatness grows herr <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 4/. Z -`Z -Z- Inspector: /4jeC-6— <br />Facility Address: /7(100 630At%ku j P*)r <br />Well Address: <br />WP# �s3lZS Wen#: <br />Soil Boring#: 4 G yT, i, g <br />Drilling Company: Ku <br />Driller Onsite: <br />Consultant: Xr-4i!` "'+- <br />Geologist: 0""e - <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 <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ Yes <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes El 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 />casing <br />height <br />ABOVE -GROUND CHRM'rY43Ox <br />COMPLETION COMPLETION <br />Ground surfa c. <br />grout <br />n. <br />n. <br />y <br />40 <br />El No Ifs( _ <br />on <br />El No <br />g-4 Pack <br />If yes, material: 1 <br />GROUTING or DESTRUCTION Total Depth: vCfr'wS IF <br />Depth to Water: n• <br />Grout Material: Neee-ere d <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation L oring Destruction <br />METHOD USED y,�//d <br />❑Pressure Grout(❑ ver Drill �IiJ1� <br />❑ Gravity FTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 1 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <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 />