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Date. <br />SAN JOAQUIN <br />COUNTY <br />Gredtne ss groes here. <br />Facility Address:.LZ& <br />Well Address: _ <br />W P# DQ 4110 <br />Soil Boring#: <br />Drilling Company. _ <br />Driller Onsite: <br />Consultant <br />Geologist: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Well#: <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 <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />❑Yes <br />❑No <br />❑No <br />❑No <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />*VEvmGROUND SENSE <br />_. <br />EWLETON COMPLETICN <br />❑No irol� J` a <br />❑ No s,tction <br />If yes, <br />GROUTING or -DESTRUCTION Total Depth:--L`L� �' -- <br />Depth to Water:{ ------- <br />Grout Material: i`��.� t��Vr�F` <br />MATERIALS/DEVELOPMENT <br />Gallons of Grout Used. '�04 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation,N <br />Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />.j Gravity 4fN <br />Tremie ❑Other: <br />Water moment 471b Water Cement 941b <br />allons 1` Ba gallons <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 <br />Feet <br />Bentonite/Cement Mix <br />3% Mix <br />5°!° Mix <br />Ba s <br />Thickest <br />Thinnest <br />it Bags <br />4.7 <br />Thickest <br />Thinnest <br />iteags <br />2.5 <br />5 <br />1 ` <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <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 />35 <br />70 <br />7 <br />17.5 <br />35 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <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 <br />Feet <br />Bentonite/Cement Mix <br />3% Mix <br />5°!° Mix <br />Bentonite per 4? Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2082, <br />4.7 <br />10/16/2017 <br />1068 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />