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SAN JOAQUIN <br />—COUNTY— <br />r`Oq,:,P`/ Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: <br />Facilitydress: 4 rOt"4- <br />Well Address: <br />WP# A3n� Well#: <br />Soil Boring#: <br />Drilling Company: fz <br />Driller Onsite: <br />Consultant: 1 .1 ""4� <br />Geologist: AA, <br />Public Water System Onsite: ❑ Yes QNo <br />Domestic Well Onsite: ❑ Yes PNO <br />If yes, location and distance: <br />LFa�LV, USIM& <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 />❑ Yes ❑ No <br />❑ Yes FI -No <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: LQ <br />Depth to Water: <br />Grout Material: W ('lM,.,r,,,1` <br />Gallons of Grout Used: n. 10 !�' WVr <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity KTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />vallons <br />Cement 94 lb <br />Bags <br />Thickest Thin est <br />#Bags <br />Thickest Thinnest <br />9Bags <br />2.s <br />55 <br />1 <br />10 <br />1 <br />5 <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 />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 <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 />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 />[ff <br />casing <br />Theight <br />R 9— <br />ABOVE-GROUND CHR*rY-BOX <br />COMPLETION COMPLETION <br />Ground SLOwt <br />grout <br />it. <br />tt. <br />ft. <br />— o <br />— o <br />abttod <br />a�c4on — <br />t.;w s --k <br />y- <br />tL <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 />