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SANhJOAQUIN <br />--COUNTY <br />' Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: � t L Z2 Inspector: s �� <br />Facility Address: ;2� Lwkit2 <br />Well Address: <br />WP# t—r77AI Well#: <br />Soil Boring#: Y <br />Drilling Company: (s -,✓v L_''4 <br />Driller Onsite: C�`��-� <br />Consultant: <br />Geologist: r-/� <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 />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />If yes, material: k <br />GROUTING or DESTRUCTION Total Depth: q9 (7 <br />Depth to Water: '9AV 4 oa -� <br />Grout Material: IN - w -r- L ^Q ti <br />Gallons of Grout Used: 1 3 --1 �s <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation goring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity VeiTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 94 lb <br />Bags <br />Thickest Thin n t <br />kBags <br />Thickest Thinnest <br />IBags <br />2.5 <br />5 10 <br />1 <br />5 10 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 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 />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 CHR351Y-BOX <br />COMPLETION COMPLETION <br />Ground Surface <br />grout <br />tt. <br />tt. <br />C <br />o <br />slotted <br />sacdan <'. '— <br />g -,e1 Pack <br />tt. =1 r ft. <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.smcehd.com <br />