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� c•- r"'�`a'- - <br />t v` � 1 <br />t'> � x I xµ <br />.�;.- <br />,,, � � ,_ <br />SAN JOAQUIN <br />COUNTY <br />Grec�tr�ess �r+��vs here, <br />�- <br />Date: � r� ti�, <br />Facility Address:_ <br />Well Addre$s:�-� <br />WP# ��� ��V <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 />Inspector: �(��►� <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 />Well#: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: "' <br />i <br />GROUTING or -DESTRUCTION- Total Depth: --------- <br />Depth to Water: �2 <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �-Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />5°!° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />2.82 <br />Thickest <br />Thinnest <br />ttBags <br />2.s <br />s <br />1 <br />s <br />10 <br />1 <br />s <br />10 <br />2 <br />— <br />1a <br />zo <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 />1i.5 <br />35 <br />Z <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: ❑Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION <br />❑ Stove Pipe ❑Christie Box <br />i .rte �. <br />=. -. <br />� �.- <br />�. - <br />�- :. <br />�. <br />i <br />��/��. <br />►!V <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 <br />11. <br />Feet <br />Bentonitel0ement Mix <br />3% Mix <br />5°!° Mix <br />Bentonite per 47 Ib <br />1.41 <br />;,r <br />-- <br />per �4 Ib <br />2.82 <br />.zti <br />.� <br />— <br />y. <br />stattQd <br />Y <br />. <br />"_' <br />�:�; <br />. <br />.. <br />��— <br />.` <br />"^"` <br />,�,� <br />�.� <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 <br />11. <br />Feet <br />Bentonitel0ement Mix <br />3% Mix <br />5°!° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite <br />per �4 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue ( Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />