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SAN JOAOUIN <br />--COUNTY— <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:GC 11���ZZ Inspector: �i t�t CONSTRUCTION <br />Facility Address: i7ll OL% e� I. <br />Well Address: - Total Depth: <br />WP# L !21 LCl Well#: Drilling Rig Type: <br />Soil Boring#:13 ,, d5 Min 2" Annular EHD Seal Verified: <br />Drilling Company: �cfwLT'� <br />❑ Yes El No <br />Driller Onsite: &A^Screen Length From: To: <br />Consultant: C,L.t1J'.4, <br />Filter Pack From: To: <br />Geologist:�1� Bentonite From: To: <br />Grout From: To: <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 />Verified Chain of Custody <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes El No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: j 01 7 <br />Depth to Water: to <br />Grout Material: { <br />Gallons of Grout Used: '- 1 SJ' <br />❑Well Installation ❑Well Destruction <br />El Boring Installation t74oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity *emie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />"Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />10 20 <br />4 <br />2 <br />40 <br />12.5 25 <br />5 <br />5 <br />50 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />MATERIALS/DEVELOPM 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />