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urk <br />/Q. �, ; SA N sJ OAQ U I N Environmental Health Department <br />( --COUNTY <br />• csuF�oa✓¢, Greutriess grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ��IZ Inspector: <br />Facility Address: "Zo 5` Ut <br />Well Address: <br />WP#_6-D0Dc Well#: <br />Soil Boring#: 5.cl, s� S.t3, SST, D7�4 <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes El No <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 />conic c <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth:�TX36161, <br />Depth to Water: <br />Grout Material: Alttzl, <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Poring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity PTremie ❑Other: <br />n <br />CONSTRUCTION <br />Total Depth: <br />Cement I <br />Basnckesat <br />Drilling Rig Type: <br />Cement 941b <br />Baits <br />Thickest Thinnest <br />Min 2" Annular EHD Seal Verified: <br />❑ Yes E] 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 />p,}r <br />ABOVE -GROUND <br />�^ Y COMPLETION COMPLETION <br />Gmund surlaos <br />01 grout <br />SS n — n. <br />V <br />_ o <br />slotted <br />sK3on <br />tFi±;w P. -k <br />IXZ5� <br />Water <br />allons <br />Cement I <br />Basnckesat <br />Water <br />ns <br />Cement 941b <br />Baits <br />Thickest Thinnest <br />#Bags <br />Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />10 <br />1 <br />5 <br />10 <br />2 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />30 <br />3 <br />10 <br />20Me <br />20 40 <br />4 <br />12.5 <br />2525 <br />50 <br />5 <br />15 <br />3030 <br />60 <br />6 <br />17.5 <br />3535 <br />70 <br />7 <br />20 <br />4040 <br />80 <br />8 <br />-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. Halzeltefl Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />