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Q'°?�U'"; � °:=�;; SAN J O A Q U I N <br />�� �-,�,�ti��,, <�� COUNT Y <br />.. 1 <br />�P � Greatness ro�,vs I -sere. <br />,` °q�rFoa'• ' 9 <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �" �?` � Inspector: _/"'''' <br />Facility Address: �D�a/� s�»y'�G , <br />Well Address: <br />WP#���'�d�OZ Well#: D - <br />Soil Boring#: <br />Drilling Company: � Ji•z' <br />Driller Onsite: y �'�' <br />Consultant: � <br />Geologist: <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 <br />❑ Yes <br />❑No <br />❑No <br />❑ Yes ❑ No <br />❑Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth <br />Depth to Water: 'd � <br />Grout Material: tPll�' <br />Gallons of Grout Used: <br />❑Well Installation Well Destruction <br />❑Boring Installation �oring Destruction <br />METHOD USED <br />L1dPressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />�5�� <br />Water <br />allons <br />Cement 471b <br />ea s <br />5% Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />4.7 <br />Thickest <br />Thinnest <br />#Bags <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 />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 />17.5 <br />35 <br />7 <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 <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: To: <br />From: To: <br />From: To: <br />From: <br />❑ Stove Pipe <br />To: <br />❑Christie Box <br />casing <br />height , <br />1lBrJYE-GROUND GtiA1STY-BOX <br />COMPLETION COMPLETION <br />(around Sumacs <br />pracrt <br />ft. <br />ft. <br />ft. <br />}, _ <br />�:�> __ o <br />.> : --- ., <br />"' — <br />�- C <br />�� o <br />slortad �.'•_ _ � <br />sacdon "' — <br />�� wac <br />�} — <br />:. <br />.�. <br />:�� - <br />tt. � = rc. <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 />Feet <br />BentonitefCement Mix <br />3% Mix <br />5% Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite 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 />