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� -��i,}j,� `, <br />�'���'---����_ SAN JOAQUIN <br />�` '-� � � COUNTY <br />i _ -_:� <br />`.��°,.��.,;:,=•-� Greatness MOWS �1+:!i'. <br />Date: c� i I u� 2Z <br />Facility Address: I6 <br />Well Address: <br />WP# � <br />Soil Boring#: <br />Drilling ComK <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: J��+ <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 />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: �0 �� <br />Depth to Water: <br />Grout Material: � C��� <br />Gallons of Grout Used: <br />❑Well Installation (Well Destruction <br />❑Boring InstallationBoring Destruction ,� <br />METHOD USED � �� <br />� �, <br />❑Pressure Grout ❑Over Drill �� <br />❑ Gravity <br />Tremie <br />❑Other: <br />Water <br />allons <br />Cement 471b <br />9a s <br />�°!° Mix <br />+Dater <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />4.7 <br />Thickest <br />Thinnest <br />tleags <br />2,5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />S <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 />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 />ca��ng <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />���J� <br />��'fe: =�rP� <br />ti 1� �'h <br />:.. - . <br />►- :. <br />r� - • <br />• r <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 />c <br />.� <br />Screen <br />Feet <br />BentonitefGement Mix <br />3% Mix <br />�°!° Mix <br />Bentanite per 47 Ila <br />1.41 <br />2.47 <br />Bentanite per 94 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 />