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SA%JOAQUIN Environmental Health Department <br />_- -- Greatness grmvs here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: <br />Facility Address: 'Ayrh`a4 7 . <br />Well Address: J ti 1'664 <br />WP# �A i. rt7 Well#: N <br />Se4.1 rthg#: (N\ ..- 'Z. Oc'7 "2,0, - "o <br />Drilling Company: �r <br />Driller Onsite:' <br />Consultant: P� <br />Geologist: <br />Public Water Sstem Onsite: ❑Yes I�No <br />Domestic Well yOnsite: ❑ Yes VNO <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Screening Method: <br />Verified Chain of Custody: El Yes ❑No <br />SPOILS <br />Contamination Noted: [I Yes ❑No <br />If yes, spoils storage Location: <br />Covered: E-1 Yes <br />❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 10 <br />g �.` � 'L <br />Depth to Water: <br />Grout Materia l: L1eA('- <br />Gallons of Grout Used: <br />Well Installation [-]Well Destruction <br />❑Boring Installation ❑boring Destruction <br />METHOD USED <br />[]PressureGrout <br />❑Over Drill <br />VJ Gravity ❑Tremie ❑Other: <br />Water Cement 471b Water Cement 9416 <br />gall s Bags <br />allons Ba s <br />Thickest Thinnest 0Bags Thickest Thinnest VBags <br />2.5 1 5 10 1 <br />s 10 2 10 20 2 <br />7,5 15 3 15 80 3 <br />10 20 4 20 40 4 <br />12,5 25 5 2s 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />CONSTRUCTION <br />Total Depth: " <br />Drilling Rig Type: CLx <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From:1s0 f <br />LS To: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION ❑Stove Pipe <br />To: <br />❑Yes ❑No <br />i `� _ <br />`Z. To: <br />To: <br />-- <br />�Christie Box <br />bqw <br />cruttsrir-Box <br />COMPLETION <br />mixing srrtxa <br />prom <br />N. <br />f1. <br />clottad <br />cacdon sg <br />cmvP1 Packft. <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 />Benkonite/Cement Mix <br />3 % Mix <br />3l Mix <br />Bentonite per471b <br />1.41 <br />2.47 <br />Bentonite per 941b <br />2.62 <br />4.7 <br />CONSTRUCTION <br />Total Depth: " <br />Drilling Rig Type: CLx <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From:1s0 f <br />LS To: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION ❑Stove Pipe <br />To: <br />❑Yes ❑No <br />i `� _ <br />`Z. To: <br />To: <br />-- <br />�Christie Box <br />bqw <br />cruttsrir-Box <br />COMPLETION <br />mixing srrtxa <br />prom <br />N. <br />f1. <br />clottad <br />cacdon sg <br />cmvP1 Packft. <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 />1o/15/zo17 <br />1808 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.coln <br />Benkonite/Cement Mix <br />3 % Mix <br />3l Mix <br />Bentonite per471b <br />1.41 <br />2.47 <br />Bentonite per 941b <br />2.62 <br />4.7 <br />1o/15/zo17 <br />1808 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.coln <br />